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Headache (Pathophysiology (Tension (Episodic or chronic (Episodic can…

- - - - Result in extravasation and inflammation
  - - - Episodic can develop into chronic
- - - - Pain lasts 4-72 hours
      - Pain is in the frontotemporal region
    - - Estrogen drop (menstrual)
      - Stress
      - Sleep disturbances
      - medications
      - Sensory stimuli
- - - - 5HT1 agonists
      - Normalize dilated intracranial arteries
      - inhibit vasoactive peptide release
      - Second gen (not sumatriptan) have higher oral bioavailability and longer T1/2 than oral sumatriptan
      - AEs
        
        Paresthesias
        
        fatigue
        
        dizziness
        
        Flushing
        
        Warm sensation
        
        somnolence
        
        Injection site rxns
        
        Chest tightness
      - Contraindications
        
        Ischemic heart disease
        
        Uncontrolled HTN
        
        Cerebrovascular disease
        
        Hemiplegic and basilar migraine
        
        Pregnancy
      - DDIs
        
        SSRIs/SNRIs: serotonin syndrome
    - - Non-selective 5HT1 agonist
      - Constrict intracranial blood vessels, inhibiting neurologic inflammation
      - Ergotamine: oral, sublingual, rectal
      - Dihydroergotamine: parenteral and intranasal
      - AEs
        
        N/V, abdominal pain, weakness, fatigue, muscle pain, paresthesias
        
        Ergotism (peripheral ischemia): numb, painful extremities, continuous parasthesias, diminished peripheral pulses, claudation
        
        Do not use within 24 hrs of triptans
      - Contraindications
        
        Renal/hepatic failure
        
        Coronary, cerebral, or peripheral vascular disease
        
        Uncontrolled HTN
        
        Sepsis
        
        Pregnant/nursing
    - - propranolol, timolol
      - divalproex
      - topiramate
      - TCAs
  - - - Only use NSAIDs 15 days/month for HA
        
        Only use combos (excedrin) 9 days/month for HA