Term
| Three primary headache types |
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Definition
Migraine
Cluster
Tension-type
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Term
| Where do secondary headaches come from? |
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Definition
Head Trauma
Vascular disorders
CNS infections
Metabolic disorders
Brain tumors |
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Term
| Description of a migraine |
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Definition
Women more than men in 20s-40s, unilateral or bilateral, mod-severe, pulsating, aggravated by activity, nausea/vomiting, light, sound, and smell sensitive, familial, and alleviated by sleep
Post-migraine: tired, dull, neck pain |
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Term
|
Definition
With aura (classic): less common type of migraine
Visual auras are most common, lasting minutes to 24 hours
Aura may be visual, sensory, or somatic
Without aura (common) |
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Term
| Pathophysiology of migraines |
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Definition
1. Problems with bloodflow to parts of brain
2. Trigeminal gets over excited
3. Trigeminal releases vasodilators: sub P, neurokinin A, calcitonin gene-related peptide
4. Vasodilation displaces brain things
5. Diminished serotonin, a vasoconstrictor play a role |
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Term
| Risk factors and triggers of migraines |
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Definition
| Stress, allergies, pressure changes, changes in sleep, alcohol, lights/sounds/smells, use or withdrawal of caffeine, smoke, hypoglycemia, OCPs, tyramine, MSG, nitrates, phenylethylamine, aspartame |
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Term
|
Definition
1. Lack of physical findings
2. Not connected to trauma and do not cause neurological damage
3. MRI/CT rules out sinus infection or other causes |
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Term
|
Definition
Avoid triggers: make diary to identify triggers
Abortive therapy: Analgesics, serotonin receptor agonists, anti-emetics |
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Term
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Definition
Tryptophan + hydroxylation + decarboxylation
7 classes with subclasses
G-protein or ligand gated channels
Vasoconstricts everywhere but skeletal muscle and heart
Contracts GI smooth muscle/starts peristalsis |
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Term
Triptans
(Sumatriptan, Zolmatriptan, Naratriptan, Rizatriptan, Almotriptain, Frovatriptan, Eletriptan) |
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Definition
Initial therapy for moderate to severe migraines
Work on head pain and nausea, etc.
Effective 4+ hours after onset of headache
Onset of drug 1-2 hours
Stimulates serotonergic
5‐HT1B/1D
receptors
Well tolerated with only tingliness, dizziness, chest tightness
Expensive
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Term
|
Definition
Reduce excitability of trigeminal and therefore release of vasodilators
Vasoconstrict by stimulation of serotonin receptors
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Term
| Triptans contraindications |
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Definition
1. Serotonin receptors on cardiac as well - not for heart disease/OD = cardiac ischemia
2. Heart or peripheral vascular disease
3. Cerbrovascular disease
4. Use with ergots, triptans, or MAOIs because of serotonin syndrome |
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Term
|
Definition
Analog of serotonin
First triptan approved
Prototype
Oral, SQ (fast acting), or nasal spray
1-2 hour half life |
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Term
|
Definition
zolmitriptan,
naratriptan,
rizatriptan,
almotriptan,
frovatriptan,
and
eletriptan
Improved bioavailability
Zolmitriptan can be nasal spray
Try switching if patient doesn't respond
Frovatriptan takes 3-5 hours to work and has a 27 hour half life
CYP3A4
inhibitors reduce eletriptan and almotriptan clearance |
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Term
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Definition
Ergotamine tartrate and dihydroergotamine
Derivatives of lysergic acid - old gold standard
Must be taken ASAP to be effective
Stimulate
serotonergic
(5‐HT1A,
5‐HT1B,
5‐HT1D,
5‐HT1F,
5‐HT2) dopaminergic,
and
noradrenergic
receptors
(many
side
effects).
Use no more than 2x per week:
nausea, vomiting, anorexia, cardiac ischemia, lower extremity circulation problems, rebound headache |
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Term
|
Definition
Ergotamine is oral, rectal, inhaled, or sublingual
Dihydroergotamine is oral, rectal, inhaled, sublingal, subcutaneous, or intramusclar.
Cheap |
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Term
|
Definition
Inhibition of release of neuropeptides
Vasoconstriction in brain
Sometimes given with caffeine to potentiate vasoconstriction |
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Term
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Definition
| Heart disease, peripheral and cerebral vascular disease, hypertension, anemia, malnutrition, kidney and liver disease, sepsis, pregnancy, breast feeding, with
triacetyloleandomycin
or
erythromycin
(inhibitors
of
ergotamine metabolism)
or
with
triptans |
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Term
|
Definition
Do not respond to conventional therapy and need parenteral treatment:
Dihydroergotamine subQ, IM, or IV with antiemetic
Sumatriptan subQ |
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Term
| Prophylactic migraine treatment |
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Definition
Criteria - impact life despite abortive treatment
more frequent than abortive treatment can be used
disabling
abortive treatment contraindicated
significant risk for future comorbidity |
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Term
|
Definition
Prophylactic migraine treatment
Beta blocker
First line due to safety and efficacy
Relief in 4-6 weeks
Dizziness, weakness, drowsiness, restlessness, tremor, nausea, bradycardia, bronchospasm
Contraindications: shock, valve disease, asthma |
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Term
|
Definition
Prophylactic migraine medication
Tricyclic antidepressant
First line due to safety and efficacy
Blocks serotonin reuptake
4-6 weeks for response
SSRIs don't work
Dry mouth, blurred vision, difficulty thinking, weight gain
Not for seizure disorders, pregnancy, children
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Term
| Verapamil and
Flunarizine |
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Definition
Migraine prophylaxis
Calcium channel blocker
Second line
Modest effect in 3 to 8 weeks
Vertigo, hypotension, nausea, muscle fatigue, constipation
Not for: severe hypotension, shock, CHF |
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Term
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Definition
Migraine prophylaxis
semi-synthetic ergot alkaloid
third line
1-2 days to kick in
adverse effects serious: GI, fibrotic changes, CAD, angina
Not for: CAD, peripheral or cerebral vascular disease, hypertension, hepatic disease, PUD, pulmonary disease, RA, pregnancy, breastfeeding |
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