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Ch 38 Headache

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1. Adj c - Rela ation therap 7. D g U ed f - Beta-blockers: Propranolol


Pha ac he a f - Biofeedback Mig ai e - Tric clic antidepressants: Amitript line
Headache - Self-h pnosis Headache - Anticon lsants: Valproic acid,
- Cogniti e therap P h a i topiramate
- Man al therap (massage) - Calci m channel blockers: Verapamil,
Diltia em
2. Ca eg ie fD g f • Aspirin (nonspecific)
- Boto : FDA appro ed for 15+
Ac e/Ab i e Mig ai e • NSAIDs (nonspecific)
migraines/month (31 injections), e pensi e
T ea e - no irre ersible effects on
platelets 8. E g A ka id - N/V: 10%
• Triptans(specific) Ad e e Effec - Prolonged asospasm
• Ergots (specific) - Dro siness
• Opioids (nonspecific): - M algias
B torphanol (nasal spra ) - N mbness tingling
• Steroids (limitede idence) - Fibrotic changes (Endocardial tiss e in
• Antiemetics: Metoclopramide or heart, Ple ral ca it , Retroperitoneal
Prochlorpera ine space)
- Offset na sea and omiting r/t
9. E g A ka id - Obstr cti e al lar disease
migraine
C ai dica i - Collagen diseases
3. Ca e f Te i - triggered b stress - Pregnanc
Headache - Diffic lt sleeping - CYP3A4 inhibitors
- Sleep d sreg lation, fatig e • - Others: same as triptan
S nlight contraindications
- An iet
10. E g a i e • Ergotamine + caffeine: Cafergot (PO, SL,
- Temperat re
F ai Rectal)
- Acti it
• Dih droergotamine (DHE)
- Tra eling; reading
(IM/IV/Intranasal)
4. Cha ac e i ic f - Rec rrent headache; attacks
11. E g a i e ed OB
Mig ai e Headache lasting 4-72 ho rs
f
- Unilateral location
- P lsating q alit ( asc lat re) 12. Fac - Ps chological
- Moderate or se ere intensit T igge i g - Medications (nitro-gl cerine)
- Aggra ation b ro tine ph sical Mig ai e - Dietar factors
acti it Headache - En ironmental, mechanical factors
- Association ith na sea and/or (so nds)
photophobia and phonophobia - Lifest le factors (s bstance ab se)
- Hormonal factors (menstr al c cle
5. C e Headache d - 1-2 attacks dail o er 2-3
changes) estrogen patch/gel can manage
months
migraine headaches r/t menstr al c cle
- pain aro nd one e e, drooping
of lid, tearing and congestion on 13. Fi ice c b caffeine, acetaminophen, & b talbital
same side of pain f

6. C e headache - CCB: Verapamil 14. Fi i a c b f caffeine, aspirin, & b talbital


- Ne rostabli ers: Di alproe 15. Headache d - practitioner m st first r le o t a
( alproate), Topiramate, Lithi m secondar headache (or more serio s
- NSAIDS: Indomethacin, ca se of headache pain)
Napro en
16. Medica i - Limit the se of aborti e medications
- Gl cocorritcoids:
O e e - Alternate headache medications
De amethasone, Prednisone
Headache Ri k - Proph lactic medications (onl if pt has
- Ergot Alkaloids: Ergotamine
Mi iga i 2-3+ headaches a month)
17. Medica i - chronic headache that de elops in 26. P h a i f - Tric clic antidepressants (TCAs) s ch
O e e response to freq ent se of headache Te i Headache as imipramine, do epin, and
Headache medicines he protript line
- resol es da s to eeks after the
27. Rec e ded - 1st line: NSAIDs (oral) or aspirin
o er sed dr g is ithdra n
O de f f (mild/moderate migraines)
- d/c the medication brings on MOH → pt
Mig ai e - 2nd line: Triptans (moderate/se ere)
res mes taking medicine (c cle)
Headache - 3rd line: Triptans + NSAID
18. Medica i *Stop taking ALL headache medications - Infreq ent headache: Ergotamine or
O e e - Triptan ithdra al: Dih droergotamine (DHE)
Headache • Mild headaches
28. Sec da - Tra ma or inj r to the head and/or
• Resol e o er se eral da s
Headache neck
- Analgesics or Ergot ithdra al:
- Cranial or cer ical asc lar disorder
• Intense headaches
- Non asc lar intracranial disorder
• Persists for 2+ eeks
- A s bstance or its ithdra al
19. Mig ai e - Trial: 2-3 months - Infection; disorder of homeostasis
Headache - Benefits happen: 4-6 eeks - Disorder of crani m, neck, e es, ears,
P h a i nose, sin ses, teeth, mo th, or other
facial or cranial str ct re
20. NOT Combination acetaminophen/narcotic
- Ps chiatric disorder
ec e ded prod cts s ch as Vicodin and Percocet
29. Se i Ag i • 5-HT(1D/1B)serotonin agonists
"T i a " - Vasocontraction
21. Pa h h i g - Ne ro asc lar disorder
- Pres naptic receptor inhibitor (red ce
f Mig ai e - Dilatation and inflammation of
release of peptides)
intracranial blood essels
• Peptiderelease
- Calcitoningene related peptide (CGRP)
- S bstance P
belie ed to promote migraine
- Ne rokinin A
- Serotonin (5HT) belie ed to s ppress
- Calcitonin gene related peptide
migraine
- Ne ronal e ent triggers asodilation 30. Te i Headache - aspirin OR acetaminophen
hich leads to pain b/c of compression 1 i e - sho ld be sed no more than 2 da s
a eek.
22. Pi a - Migraine
Headache - Tension-t pe headache (TTH) 31. Te i Headache - NSAIDs, caffeine-containing
- Trigeminal a tonomic cephalalgias 2 d i e analgesics
(TACs) - E cedrin migraine: aspirin &
- Sin s headache acetaminophen
• Cl ster headache (Unilateral pain ith
32. Te i Headache - b talbital-containing compo nds
ipsilatera la tonomic s mptoms:
3d i e (Fioricet or Fiorinal)
lacrimation, nasal congestion, m osis,
- sho ld ne er be sed more than 3
ptosis, conj nctional redness, rhinorrhoea
da s per month
23. P h a i f More than 2 Headaches/Week - Can be sedating
Te i
33. Te i headache 1st line: Aspirin, Acetaminophen (best
Headache d
de 1st line)
24. P h a i f - *Amitript line (Ela il) 2nd line: NSAID, Ib profen, Napro en,
Te i - gi e at bedtime E cedrin Migraine
Headache - co ld impro e depression r/t sleep 3rd line: B talbital
1 i e changes
34. Ti a Ad e e - Tingling
- anticholinergic side effects
Effec - Warmth
- risk for cardioto icit
- Inj n site reactions
25. P h a i f - Venlafa ine: (Effe or, - Chest discomfort (1-5%): hea arms,
Te i aserotonin/norepinephrine press re
Headache re ptake inhibitor or SNRI) - Coronar asospasm (rare)
2 d i e - Mirta apine: (Remeron, tetrac clic - Poor taste
antidepressant)
35. Ti a c ai dica ed - Coronar arter disease or risk factors for CAD
-Stroke
- Uncontrolled HTN
- Peripheral asc lar disease
- Ischemic bo el
- Pregnanc
36. Ti a d g i e ac i - MAOIs: ithin 2 eeks
- SSRIs: se ca tion
- Ergots: ithin 24 hr
- Propranolol ↑ concentrations of Ri atriptan
- Eletriptan/Naratriptan: contraindicated in renal and hepatic impairment

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