NU553 Unit 3 Headaches Advanced Pharmacology and Pharmacotherapeutics Exam 2

What is the key difference between primary and secondary headache?

Primary has no identifiable cause, secondary does

What headache presentation is a red flag that needs urgent evaluation?

Sudden thunderclap headache or new onset after age 50.

Patient says this is the worst headache of my life. What should you suspect?

Subarachnoid hemorrhage.

Headache plus fever and stiff neck should make you think of what?

Meningitis.

What headache type presents as bilateral, pressing, mild to moderate, no nausea or vomiting.

Tension headache

First-line treatment for tension headache?

Acetaminophen or NSAID

First-line prevention for tension headache?

Amitriptyline.

Unilateral, pulsating, moderate to severe, worse with activity, nausea or light sensitivity.

Migraine

How long does a typical migraine last?

4 to 72 hours.

Besides pain, what is a common most-bothersome migraine symptom?

Photophobia.

First-line acute treatment for mild migraine?

Acetaminophen or NSAID

First-line acute treatment for moderate to severe migraine?

Triptan.

When should triptan be taken in migraine with aura?

At onset of headache, not aura.

What is the mechanism of action of triptans?

Serotonin 5 HT 1B and 1D receptor agonist.

Which patients should not use triptans?

Cardiovascular disease, stroke, uncontrolled hypertension.

How long should you avoid ergot after taking a triptan?

24 hours.

Patient has severe migraine with vomiting and needs the fastest-acting triptan. Best choice?

Subcutaneous sumatriptan.

Which triptan has the longest half-life?

Frovatriptan.

Calcitonin gene related peptide receptor antagonists.

Gepants

What is the key advantage of gepants over triptans?

No vasoconstriction.

What drug class does lasmiditan belong to?

Selective serotonin 1F receptor agonist.

What is the key counseling point for lasmiditan?

Do not drive for 8 hours.

When is migraine prevention indicated?

Four or more headache days per month or disabling attacks.

What is the goal of migraine prevention?

Reduce frequency by 50 percent.

Which drugs are first-line for migraine prevention? (3)

Beta blockers, topiramate, valproic acid.

When should beta blockers be avoided in migraine prevention?

Asthma or severe COPD

What adverse effects should you think of with topiramate? (3)

Cognitive slowing, kidney stones, paresthesias.

What is a major contraindication to valproic acid in migraine prevention?

Pregnancy due to teratogenicity.

What timeframe counts as chronic migraine?

15 or more headache days per month for more than 3 months.

What is status migrainosus?

Migraine lasting more than 72 hours.

What type of headache presents as severe unilateral orbital pain with autonomic symptoms and restlessness.

Cluster headache

What timing pattern is classic for cluster headache?

Occurs at night.

Best acute treatment for cluster headache?

High flow oxygen or subcutaneous sumatriptan.

Best prevention for cluster headache?

Verapamil.

What pattern suggests medication overuse headache?

Using analgesics more than 2 days per week.

Treatment for medication overuse headache?

Stop overused medications.

Which medications commonly cause medication overuse headache?

Caffeine, opioids, butalbital.

High risk of dependence and medication overuse headache.

Butalbital

How often can triptans be used before overuse becomes a concern?

Less than 10 days per month.

Safest headache medication in pregnancy?

Acetaminophen.

Migraine with aura plus estrogen-containing contraceptives increases what risk?

Increased stroke risk.

What is the mechanism of action of calcitonin gene related peptide monoclonal antibodies?

Block calcitonin gene related peptide pathway.

When is botulinum toxin used in headache treatment?

Chronic migraine prevention.

What is a common migraine trigger related to hormones?

Estrogen withdrawal.

Most common non-drug therapy used for headache management?

Lifestyle and physical therapy.