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