My Head Hurts

Tension

100

First line treatment for acute tension-type headache (TTH)

Analgesics - Naproxen, Excedrin, Ibuprofen, Aspirin, Acetaminophen (APAP)

200

Criteria for tension-type headache (TTH)

At least 2 of the following: bilateral head pain lasting from 30min to 7 days, steady non pulsating pain, mild to moderate pain intensity, and normal physical does not aggravate the headache

PLUS no aura, N/V, photophobia or phonophobia 

300

Combination analgesic products and what the concern is

Fioricet - butablbital/APA/caffeine (not controlled, "FioriSET to write")

Midrin - isometheptene/dichloralphenazone/APAP (vasoconstrictor, sedative, analgesic) 

Concern is overuse leading to more headaches

400

Non-responders to OTC NSAIDs should be prescribed

Prescription NSAIDS - Diclofenac 

500

Prophylaxis options

TCA - start low and titrate up. Amitriptyline QHS, contraindicated in severe heart disease 

Skeletal muscle relaxants - take at first sign of tension

Botox 

Cluster + Essential Tremor

100

Abortive therapy for cluster headache

100% oxygen on nonrebreather

Subcutaneous sumatriptan, intranasal sumatriptan or zolmitriptan, ocreotide (can be used in patients w/HTN or CVD), intranasal lidocaine 

200

Prophylaxis for cluster headaches

Verapamil (preferred) 

Lithium - lots of SEs and cautions

Ergotamine 

Corticosteroids - prednisone taper

Nerve block 

Galcanezumab (Emaglity) 1x at cluster period onset then monthly until end of cluster period

300

Criteria for cluster headaches

At least 5 attacks of severe unilateral orbital, supraorbital, and/or temporal pain lasting 15-80min if untreated

Also has running nose, runny eyes, congestion, eyelid edema, forehead and facial sweating, ptosis, agitation, etc.

400

First line treatment for essential tremor, AEs, and contraindications

Propanolol: AEs= lightheadedness, fatigue, impotence, bradycardia, CIs= heart block, asthma, T1DM

500

Second line treatment for essential tremor, AEs, and monitoring

Primiodone - AEs= (worse initially) sedation, drowsy, fatigue, depression, vertigo, monitor = levels and CBC q6mo

Migraine Pt. 1

100

Non-pharmacologic treatment for migraines 

Ice, rest, and dark quiet room 

200

Set up approach to treat migraines 

Mild-moderate --> NSAIDs, ant-emetics, analgesics

Moderate-severe --> Triptans, ergot alkaloids 

300

First line abortive therapy for migraines and contraindications

Triptans - ischemic heart disease, uncontrolled HTN, stroke, basilar or hemiplegic migraines 

Rizatriptan and Sumatriptan 

400

Second abortive therapy, side effects, and CI

Vasoconstriction, HTN, peripheral ischemia

CI: CAD, PVD, HTN, PREGNANCY (X)

Dihydroergotamine (Migranal)

500

Opioids as an option for migraine abortive therapy 

Effective as rescue but potential for abuse and can be lead to rebound headaches 

Migraine Pt. 2

100

Fioricet, antiemetics, migraine cocktail, steroids would be used for what and when

Migraines abortive therapy 

200

Very sedating drug used for migraine abortive therapy

Lasmiditan - don't drive for at least 8 hours after taking 

300

First choice migraine prophylaxis and some other options

Beta blockers (Propanolol and Timolol), CCB (Verapamil), NSAIDs, TCAs, SSRIs, atypical antidepressants, anticonvulsants (Topiramate, Valproic Acid, Carbamazepine)

400

New-er migraine prophylaxis options

Botox, CGRP/monoclonal antibodies 

500

Monoclonal antibodies/CGRP anatgonists should be avoided in these populations

Pregnant, likely to become pregnant, with or high risk of CVD

Parkinson's

100

Peripherally acting drugs

Levodopa, COMT Inhibitors

200

Centrally acting drugs

MAO-B inhibitors

300

Drugs that cause dyskinesias

Levodopa, dopamine agonists, apomorphone, COMT Inhibitors, MAO-B Inhibitors

400

Drug that's supposed to reduce dyskinesias

Amantadine 

500

Drug class has lots of DDIs

Dopamine agonists