Peter Test 2

- Most common type of headache

- Triggered by stress

- Usually moderate pain that goes away in a short period of time

tension headache

- Hydration

- Cognitive behavioral therapy (CBT)

- Relaxation

- Biofeedback

tension headache non-pharm

- Acetaminophen (+/- caffeine)

- NSAIDs

tension headache pharmacologic

- Rare, but cause severe pain (typically behind one eye)

- Typically last a short amount of time

- Occur multiple times throughout a day for a few weeks

cluster headache

- Alcohol

- Smoke

- Seasonal changes

cluster headache triggers

- Oxygen

- Triptans

cluster headache treatments

verapamil

cluster headache prophylactic treatments

- Moderate to severe pain

- Typically occur a couple times a month

migraines

- Diet

- Hormones

- Stress

- Sleep disturbances

migraines triggers

- prodrome

- aura

- headache

- postdrome

migraine phases

- Brain fog

- Mood changes

prodrome

Tingling (in the face or arms)

aura

- N/V

- Light/sound sensitivity

- Throbbing pain

headache

tiredness

Postdrome

- Activation of first-order trigeminovascular neurons

- Release of vasoactive pepties (CGRP)

- Discharge of second-order neurons in the brain stem, and then third-order neurons in the thalamus

- Areas of the brain responsible for pain protection are reached

migraines path

- Acetaminophen

- NSAIDs

acute (abortive treatment) first line Mild-to-moderate

Triptans (selective 5-HT receptor agonists)

acute (abortive treatment) first line moderate-to-severe

- Dihydroergotamine (ergot alkaloid)

- Lasmiditan (Reyvow)

- Gepants

- Opioids

- Antiemetics

acute (abortive treatment) second line

- First-line abortive treatment for mild-to-moderate migraines

- Reduce prostaglandins

NSAIDS MOA

- Caffeine

- Butalbital

- Codeine

NSAIDs can be used in combination with

Acetaminophen/aspirin/caffeine

excedrine

Should be taken with food to avoid GI upset

NSAIDs counseling

can lead to medication overuse headaches (rebound headaches)

NSAIDs continuous use

- Selective 5-HT Receptor Agonists

- First-line abortive treatment for moderate-to-severe migraines

- Should be taken at the onset of a migraine

- Vasoconstrict in the brain

- Reduce CGRP release

- Reduce Neurogenic inflammation

- Reduce Pain transmission

Triptans MOA

- N/V

- Chest tightness

- Burning sensations

- Dizziness

Triptans AEs

- Risk of serotonin syndrome

- SSRIs

- SNRIs

- MAO inhibitors

Triptans DDI

- Second-line acute abortive treatment for migraines

- Non-selectively agonizes 5-HT1 receptors

- Causes vasoconstriction

- Inhibits CGRP release

Dihydroergotamine (Ergot Alkaloid) MOA

- oral bioavability is poor

- Injectable

- Rectal

- Nasal spray

Dihydroergotamine routes of administration

Life-threatening cerebral/peripheral ischemia

Dihydroergotamine BBW

- Pregnancy

- Propranolol

- MAO inhibitors

- Ischemic disease

- Uncontrolled HTN

Dihydroergotamine CI

- N/V

- Chronic ergotism (drowsiness, vertigo, cold extremities)

- Vasospasms

Dihydroergotamine AE

- Second-line abortive treatment for migraines

- Selectively agonizes 5-HT

- Inhibits trigeminovascular and CNS pain transmission

- Does not cause vasoconstriction

Lasmitidan (Reyvow) MOA

- Sedation

- Dizziness

- N/V

- Paresthesia

Lasmitidan (Reyvow) AEs

- CNS depressants

- Strong CYP3A4 inhibitors/inducers

Lasmitidan (Reyvow) DDI

- Schedule V drug (due to CNS depression)

- Do not drive for at least 8 hours after each dose

Lasmitidan (Reyvow) counseling

- Second-line abortive treatment for migraines

- Antagonize CGRP receptors

- Effective for both migraine prevention and treatment

- Great drugs for patients with cardiac issues

- Typically expensive, but work well

Gepants (CGRP antagonists) MOA

Liver damage

Gepants (CGRP antagonists) AE

CYP3A4/P-gp inhibitors

Gepants (CGRP antagonists) DDI

Are never really recommended for migraines

opioids

- opioid

- Nasal spray

- Mixed MOA (kappa-opioid receptor agonist & mu-opioid receptor antagonist)

Nutorphanol

- Can be used 15-30 minutes before abortive treatment if needed

- Block dopamine receptors in the CTZ

antiemetics MOA

- Metoclopramide

- Chlorpromazine

- Promethazine

antiemetics drugs

- Is using abortive treatment more than 2-3 times per week or 3 times per month

- Has debiliating attacks despite treatment

- Is unable to tolerate abortive treatment

- Has chronic migraines (>15 monthly headache days)

- Is experiencing medication overuse headaches

migraine prophylaxis can be added if patient

- antihypertensives

- antiepileptics

- antidepressant

- analgesics

- Botox

- CGRP antagonists

migraine prophylaxis drugs

- Propranolol

- Verapamil

- Lisinopril

antihypertensives drugs

- Topiramate

- Valproic acid

antiepileptics drugs

amitriptyline

antidepressants drugs

NSAIDs

analgesics drugs

controversial, but can still be used

BOTOX

gepants

CGRP antagonists

- soreness

- mayalgia

- sprains

- strains

- tendonitis

- bursitis

- low back pain

common soft tissue injuries

due to overexertion

soreness

- Muscle pain

- Infection

- Chronic disorders

- Medications

Myalgia

Stretching/tearing of ligaments

Sprains

- "RICE" (rest, ice, compression, elevation)

- PT

- Surgery

sprains treatment

Injuries to muscles/tendons

strains

- "RICE"

- PT

strains treatment

Inflammation of a tendon

Tendonitis

- Reduce stress

- NSAIDs

- Steroid injection

tendonitis treatment

Inflammation of bursae between bones

Bursitis

- NSAIDs

- Fluid removal

- Steroid injection

Bursitis treatment

Sudden injury

acute back pain

- Lasts more than 12 weeks

- Occurs daily

chronic back pain

- Oral/topical analgesics

- Heat (if pain is non-inflammatory)

low back pain treatment

Apply for 15-20 minutes 3-4 times a day

heat

- Heat

- Alcohol

- Running

- Massage

treatment for soft tissue injuries do not HARM

- Protection

- Elevation

- Avoid anti-inflammatories

- Compression

- Education

treatment for soft tissue injuries PEACE for immediate care

- rest

- ice

- compression

- elevate

RICE

- Can more often than not be treated at home with oral NSAIDs or acetaminophen

- Important to keep AEs in mind though

- Topical NSAIDs and anesthetics can work great and have minimal AEs

- Intra-articular or IM injections can potentially be used as well

- Treat for 4-6 weeks or longer

treatment Strategies for Soft Tissue Injuries

- Water-based treatment cleans burns

- It's important to stay hydrated as part of treatment

- Pain or anxiety medications can be used (since changing wound dressings can be very painful)

- Bacitracin or silver sulfadiazine cream can be used if needed

burns