Term
| How are headaches classified? |
|
Definition
Primary = no underlying pathology
Secondary = underlying pathologic condition |
|
|
Term
| List the 3 types of Primary Headaches |
|
Definition
1. Migraine (can be w/ or w/out an Aura)
2. Tension Type
3. Cluster headache |
|
|
Term
| What are the severity levels of a headache? |
|
Definition
1. Mild = can do daily routine
2. Moderate = inhibits daily acitivity but not incapacitating
3. Severe = Incapacitating
4. Status = Severe headache lasting > 72 hrs |
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Term
| How do you diagnose headaches, in general? |
|
Definition
1. Rule out secondary causes by checking for abnormalities (vital signs, neurologic exams, etc)
2. Headache history questions (characteristic of pain, Rx used, impact on life, family hx, etc) |
|
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Term
| What type of questions are on a headache diary? |
|
Definition
1. Date
2. Time (start/finish)
3. Intensity (scale of 1-10 (most severe))
4. Preceding symptoms
5. Triggers
6. Medication and dosage
7. Relief ? |
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|
Term
| Are migraines higher in men or women? |
|
Definition
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|
Term
| What is the age of onset for migraines? When does it peak? |
|
Definition
10-29 yro
Peak at 35-45 yro |
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Term
| Migraines are a feeling of throbbing head pain (recurrent) in ________________location. |
|
Definition
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|
Term
| Migraines can occur at any time of the day but most commonly it occurs in ____________ and can last from ____________ hrs. |
|
Definition
The a.m. when you first wake
4-72 hrs |
|
|
Term
| List some symptoms of migraines. |
|
Definition
1. Sensitivity to light & sound
2. Blurr Vision
3. Nausea/Vomitting
4. Diarrhea
5. Constipation
6. Anoxeria
7. Food cravings
8. Localized edema
9. Ab cramps
10. Nasal stuffiness |
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|
Term
| To be diagnosed with a migraine w/out Aura you need to have at least ____________ attacks whereas a migraine w/ an Aura you need to have at least _________attacks. |
|
Definition
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|
Term
| An aura symptoms lasts between _______ and _______ mins. |
|
Definition
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|
Term
| What is an example of a positive aura symptom? |
|
Definition
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Term
| What are some triggers to migraines? |
|
Definition
1. Environment (small, light, loud noise, etc)
2. Behavioral/physiologic ( stress, no sleep, skipped meals, etc)
3. Rx
4. Food (caffeine, EtOH, aged cheeses, Chocolate, nitrates, nuts, etc) |
|
|
Term
| What is a non pharmacological approach to treat migraines? |
|
Definition
1. Avoid triggers
2. Apply ice to head
3. rest in dark place
4. Good eating habits
5. Stop smoking
6. Limit caffeine
7. Regular sleep and exercise |
|
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Term
| T/F: There are some OTC products that are better to treat migraines. |
|
Definition
| False; no OTC is better than the other. It depends on the patient |
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Term
| Most patients seek self treatment. When should they be reffered to a physician? |
|
Definition
1. If > 50% disability (daily activities)
2. > 20% vomiting
3. If < 15 days/ month are headache free
4. Failure of 2 or + OTC products |
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|
Term
| What does A-U-S-T-I-N stand for? |
|
Definition
A = Aggravation by activity
U = Unilateral location
S = Sensitivity to light/sound
T = Throbbing
I = Intensity
N = Nausea/Vomitting |
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Term
| Patients should limit the use of OTC to ___________ days per week; trying to avoid over use headaches |
|
Definition
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Term
| Ken comes to the pharmacist and tells you this is the 4th OTC product he is trying to treat his headache. What do you tell him? |
|
Definition
Refer to doctor.
Failure of 2 or more OTC products need referral |
|
|
Term
| Why is stratified care the most beneficial approach compared to step care, when treating migraines? |
|
Definition
1. It assests the headache and treats based on the severity.
2. It can be cheaper for the patient.
3. Patient specific
4. Greater response rate |
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|
Term
| If we are using the stratified care to treat Migraines how do we approach the different levels of disabilities? |
|
Definition
Low disability = OTC
Moderate disability = OTC and Rx
Sever Disability = Migraine Rx and Preventative Rx |
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|
Term
| T/F: Stratified Care approaches each patient the same and is lost to follow up/treatment failures. |
|
Definition
| False; this describes Step Care |
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|
Term
| Does acute treatment of migraines effect auras? |
|
Definition
|
|
Term
| Why do you want to limit the use of OTC treatment to 2-3 / week? |
|
Definition
| To prevent overuse headaches |
|
|
Term
| How many headache episodes should you treat on your own? |
|
Definition
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|
Term
| For moderate to severe headaches use ______________. |
|
Definition
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Term
| List the Rx used for moderate to severe migraines. |
|
Definition
1. Ergotamines
2. Triptans
3. Opiods
4. NSAIDs
5. Corticosteroids
6. Butorphanol Nasal spray
7. Antiemetics |
|
|
Term
| If a patient has a severe migraine and nausea/vomitting what should they take? |
|
Definition
A anti-emetic before treating
or
use a non oral Rx |
|
|
Term
| What is one advantage of the use of ergotamines? |
|
Definition
| They have many dosage forms. From oral to rectal to intranasal, parenteral. |
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|
Term
| T/F: Ergotamines have many ADRs, the most common is nausea and vomitting. |
|
Definition
|
|
Term
| If your taking an ergotamine, what should be avoided for 24hrs? |
|
Definition
|
|
Term
| What patients cannot use Ergotamines? |
|
Definition
1. Pregnant
2. Renal/liver failure
3. Nursing
4. Uncontrolled HT
5. Sepsis
6. Coronary, cerebral, or peripheral vascular disease |
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|
Term
| What triptan is considered the gold standard? |
|
Definition
|
|
Term
| What is the best triptan to use? |
|
Definition
Whichever is best for the patient.
It varies by:
onset/duration
efficacy
drug interactions
metabolism
ADR |
|
|
Term
| What is the only first generation triptan? |
|
Definition
|
|
Term
| What are some benefits of 2nd generation triptans? |
|
Definition
1. lower headache recurrence rate
2. Shorter onset action
3. Fewer ADR |
|
|
Term
| What are some side effects you need to counsel your patient who are taking a triptan? |
|
Definition
May experience: dizziness, drowsiness, tingling and chest pain.
BUT
if they dont get relief within 30-45 mins they want to seek medical attention *may b a stroke* |
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Term
| If a patient is taking Rizatriptan and Propanilol, what should you do to the dose of the Rizatriptan and why? |
|
Definition
Reduce the dose by 50%.
The Propanilol increases the concentration of Rizatriptan by 70%. |
|
|
Term
|
Definition
A combo Rx
85mg Sumatriptan with 500 mg Naproxen |
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|
Term
| What is the dosing for Treximet? |
|
Definition
1 tablet at onset of headache and may repeat in 2 hrs.
Max = 2 tablets/24 hrs |
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|
Term
|
Definition
| Diclofenac and KHCO3 50 mg soluble powder |
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Term
| T/F: Cambia should be taken on an empty stomach only. |
|
Definition
| False; It does improve its efficacy if taken on empty stomach but you may want to take with food to protect the stoamch |
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Term
| When should prophylactic treatment used for migraines? |
|
Definition
1. 4 or more migraines a month
2. Contraindication or ADR w/ acute Tx
3. Cost
4. Predictable headache patterns
5. Disability even after being treated |
|
|
Term
| With prophylactic treatment you want to start _______ and go _______. It takes about ________ to measure efficacy. |
|
Definition
|
|
Term
| What is type of Rx is considered to be first line when it comes to prophylactic treatment? |
|
Definition
| Beta Blockers (80% effective) |
|
|
Term
| Which Beta Blocker is the DOC for prophylactic treatment? |
|
Definition
| Propranolol (80-240 mg/day divided) |
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|
Term
| The anticonvulsant Topiramate can cause _______________ so you want to counsel your patient to drink with a full glass of water. |
|
Definition
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|
Term
| Valproaic acid can cause ____________________ that is why you want to measure/check ____________. |
|
Definition
Hepatotoxicity
Liver enzymes |
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|
Term
| NSAIDs as prophylatic therapy is mainly used in preventing headaches that recur _________________. |
|
Definition
| in a predictable pattern like period migraines |
|
|
Term
| What is the most common cause of chronic daily headaches? |
|
Definition
Overuse of headaches medications
Taking Rx 10-15 days/month |
|
|
Term
| What can you use for menstrual migraines? |
|
Definition
Tx 2-3 days prior to onset of menses
NSAIDs
Triptans
Estrogen |
|
|
Term
| If a migraine is induced by birth control, what can a patient do/use? |
|
Definition
1.Change the formulation
2. Take a progestin only pill
3. Discontinue the OC
4. Start B6 vit.
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|
|
Term
| What Rx can a pregnant women use to treat migraines? |
|
Definition
|
|
Term
| If pregnant when prophylactic treatment should be avoided and why? |
|
Definition
Valproic acid = Tetratogenic
NSAIDs in 3rd trimester |
|
|
Term
| What is the 2nd/3rd DOC for prophylatic treatment? |
|
Definition
Verapamil (most common)
and
Nifedipine |
|
|
Term
| Mg can be used as a prophylatic treatment. What is the major side effects associated with it? |
|
Definition
Soft Stools/Diarrhea
Palpitations |
|
|
Term
| What is the most common type of primary headache? |
|
Definition
|
|
Term
| T/F: Onset of tension headaches is early in life. 40% is younger than 20 yro. |
|
Definition
|
|
Term
| What is the clinical presentations of a tension headache? |
|
Definition
1. Mild to moderate pain
2. Can last 30 mins to 7 days
3. Dull, nonpulsatile tightness or pressure
4. Bilateral location
5. Mild photophobia/phonophobia
6. Not that disabling |
|
|
Term
| How are Tension Headaches classified? |
|
Definition
|
|
Term
| What are episodic tension headaches? |
|
Definition
Headaches occuring > 1 day but < 15 days a month
(< 180 days/yr) |
|
|
Term
| What are Chronic Tension Headaches? |
|
Definition
Headaches that occur > 15 days/month
or
(>180 days/yr) |
|
|
Term
| What can you use to treat mild to moderate tension type headaches? |
|
Definition
1. NSAIDs
2. Simple Analgesics |
|
|
Term
| When should prophylatic treatment occur when having tension type headaches? |
|
Definition
| When they have a headache frequency of more than 2x/week lasting for more than 3-4 hrs. |
|
|
Term
| What is the most effective prophylatic treatment for Tension Type Headaches? |
|
Definition
|
|
Term
| Of the primary headaches which is the most severe form? |
|
Definition
|
|
Term
| Cluster Type Headaches is more common in _______________. |
|
Definition
|
|
Term
| What are the clinical presentations of Cluster Headaches? |
|
Definition
1. Occur suddenly w/no auras
2. Excruciating/penetrating pain lasts 15-180 mins
3. Dull intensity
4. Lacrimation
5. Facial Sweating
(more symptoms--those are the main) |
|
|
Term
| T/F: Cluster headaches occur mostly at night, and you can have up to 8 attacks a day. |
|
Definition
|
|
Term
| How do Cluster attacks occur? |
|
Definition
| In periods of attacks lasting 2 wks to 3 months followed by a long pain free interval (can b 2 months to 20 yrs) |
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|
Term
| An Episodic Cluster Type headache is classified by having attacks lasting _________ to _______ w/pain free period lasting 1 month or longer. |
|
Definition
|
|
Term
| T/F: Chronic Cluster Type Headaches are classified as attacks lasting more than 1 yr w/out remission or with remission lasting less than 1 month. |
|
Definition
|
|
Term
| What are some Acute treatment options for Cluster Type Headaches? |
|
Definition
1. O2
2. Ergots
3. Triptans |
|
|
Term
| Which Triptan is the most effective for acute treatment of Cluster Headaches? |
|
Definition
|
|
Term
| What are some prophylatic treatment options for Cluster Headaches? In what doses? |
|
Definition
1. Lithium (600-1200 mg/day)
2. Verapamil (360- 720 mg/day)
3. Lithium + Verapamil
4. Methylsergide (4-8 mg/day)
5. Corticosteroids (40-60 mg/day)
6. Ergots (1-2 mg/day) |
|
|
Term
| When it comes to location, both migraine and cluster headaches are ______________, whereas Tension headaches are ____________. |
|
Definition
|
|
Term
| List the duration of migraine, tension and cluster headaches. |
|
Definition
Migraine = 4 hrs to 72 hrs
Tension = 30 mins to 7 days
Cluster = 15 minutes to 180 minutes |
|
|
Term
| Before puberty, do boys or girls have a higher incidence of headaches? |
|
Definition
Boys do!
But after puberty, because of estrogren flux, migraines and tension headaches are greater in girls. |
|
|
Term
| What are some acute treatment options for children w/ headaches? Provide the doses |
|
Definition
1. Acetamenophen = 15 mg/kg/dose
2. Ibuprofen = 10 mg/kg/dose
3. Naproxen = 2.5-5 mg/kg/dose |
|
|
Term
| When should children seek prophylatic therapy for their headaches? |
|
Definition
1. If its severe in nature
2. At least 3 headaches/month
3. Functional disability |
|
|
Term
| T/F: Triptans are FDA approved for use in children. |
|
Definition
| False; not approved but has shown to be efficacious in > 12yro |
|
|
Term
| Which is the preferred prophylactic treatment for cluster headaches? |
|
Definition
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