Term
| FIGURE 1 pg 200... types of Headaches |
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Definition
| FIGURE 1 pg 200... types of Headaches |
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Term
Analgesics for mild to moderate HA?
To avoid analgesic induced HA, how long should these be used for ? |
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Definition
ASA, Ibuprofen, APAP, Butalbital, Naproxen
Do not use for more than 15 days per month to avoid analgesic induced HA |
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Term
| How long should opioid and combination analgesics be used for ? |
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Definition
| No more than 10 days per month |
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Term
Role of Ergotamine in HA ?
What limits its use? Name them
Contraindications |
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Definition
Ergotamine is used for cluster HA or migraines...
Side effects including Chest pain, tingling, nausea, vomiting, paresthesias, & ergot dependence limit its use
Contraindications: Pregnancy, cardiac disorders, HTN, sepsis, potent inhibitors of 3A4 |
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Term
Dihydroergotamine mesylate (DHE)
Uses ?
Dependence ?
Side effects?
Contraindications? |
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Definition
Dihydroergotamine mesylate (DHE)
Uses - Can be used for acute intractable headache or withdrawal from analgesics
Dependence - NO, whereas ergotamine DOES
Side effects & Contraindications - SAME as ergotamine: Side effects including Chest pain, tingling, nausea, vomiting, paresthesias
Contraindications: Pregnancy, cardiac disorders, HTN, sepsis, potent inhibitors of 3A4 |
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Term
| Sumatriptan SQ place in therapy |
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Definition
| SQ Sumatriptan - Fastest onset of action and most efficacious for SEVERE migraine. Also efficacious in cluster HA. |
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Term
| Naratriptan Place in therapy |
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Definition
Slowest onset of action (max efficacy at 4 hours).
*SE's near placebo
Naratriptan good for MODERATELY SEVERE migraine attacks, or for individuals with low tolerance to triptan SE's |
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Term
| Limit on use per month in triptans? |
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Definition
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Term
| Contraindications of triptans? |
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Definition
| Cardiac disorders, hypertension, basilar (back portion of the head, causes aura, vertigo, tinnitus) and hemiplegic (paralysis on one side of the body) migraine |
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Term
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Definition
| Chest discomfort, dizziness, paresthesias, fatigue |
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Term
| What kind of HA disorders are corticosteroids useful in? |
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Definition
| Corticosteroids are useful in status migrainosus, cluster HA, cerebral neoplasms with edema, temporal arteritis |
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Term
Treatment Resistant HA, what agent should be used?
Last resort agent? |
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Definition
Treatment Resistant HA, what agent should be used - Ketorolac
Last resort agent - Meperidine IV or IM |
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Term
| In what kind of HA is indomethacin useful |
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Definition
| Chronic Paroxysmal hemicrania |
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Term
What antinauseant agent is useful as an adjunctive therapy in HA ?
What antiemetic/prokinetic agents are useful? |
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Definition
Anti-nauseant: Dimenhydrinate
Antiemetic/prokinetic: Metoclopramide or Domperidone |
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Term
| When is prophylaxis vs migraines warranted? |
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Definition
If attacks interfere with QoL,
or
3 or more attacks per month that fail to respond to symptomatic therapy |
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Term
| Which BBs used for prophylaxis ? Which cause fewer CNS SE's? |
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Definition
Propranolol - most studied
Nadolol & atenolol have fewer CNS effects because they do not cross the BBB |
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Term
CCBS in HA prophylaxis?
Which vs. cluster?
Which vs. Migraine? |
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Definition
Verapamil vs cluster
Flunarizine vs migraine |
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Term
TCAs for HA?
Do they produce dependence? |
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Definition
Amitriptyline, nortriptyline, doxepin effective for tension HA
DO NOT produce dependence |
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Term
What antiepileptic drugs are good prophylaxis for HA?
Special note about these? |
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Definition
Valproic Acid and divalproex sodium good migraine prophylaxis
BOTH TERATOGENIC! |
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Term
In what patients should topiramate be avoided for HA prophylaxis ?
Side effect? Positive side effect? |
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Definition
Avoid in Renal stones
Can increase ocular pressure and cause weight loss |
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Term
| Serotonin Antagonists used for prophylaxis vs HA? |
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Definition
Pizotifen - Maximal dosage, if tolerated
Methysergide - REMOVED FROM MARKET due to long term SE's |
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Term
| Riboflavin efficacy in migraine prophylaxis? |
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Definition
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Term
| What can lithium be used for in HA prophylaxis? |
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Definition
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Term
| Most common time for migraines in pregnancy? |
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Definition
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Term
| First line for mild HA in pregnancy/postpartum |
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Definition
| Lifestyle changes, occasional APAP |
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Term
| When should Ibuprofen or Naproxen be avoided in pregnancy? |
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Definition
| Avoid in later stages... Can be used during first or second trimester ONLY |
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Term
| Ergot derivatives in pregnancy? |
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Definition
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Term
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Definition
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Term
| Barbiturates in pregnancy |
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Definition
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Term
| Indomethacin in pregnancy |
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Definition
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Term
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Definition
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Term
| Preferred Severe HA prophlyxis in pregnancy |
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Definition
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Term
| Acetaminophen in breastfeeding? |
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Definition
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Term
Triptans in Breastfeeding?
Triptans in Pregnancy? |
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Definition
OK in breastfeeding - most studied
AVOID in pregnancy |
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Term
| HA prophylaxis while breastfeeding? |
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Definition
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Term
| Divalproex Sodium as prophylaxis in breastfeeding? |
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Definition
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Term
| Important counseling point of triptans |
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Definition
Do not use a triptan within 24 hours of another triptan
Do not use more than 10 times per month |
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