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Informatics in Pharmacy

Headache

August 13, 2018 By Dr. G, PharmD

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Acute:

  • Treat with NSAIDS, APAP, 5-HT receptor antagonists (triptans).
  • Prophylaxis: Avoid precipitants, TCAs, propranolol, topiramate, verapamil, valproic acid, NSAIDs, Botox, Magnesium, Vitamin B12, CoQ10, feverfew

Migraine:

  • If they are recurrent, interfere with daily activities or patient prefers prophylactic therapy, prophylaxis should be considered. Use lowest effective dose, give 2 – 3-month trial, consider a choice that also helps with comorbidity
  • Possibilities: Frovatriptan for menstrual migraines, metoprolol (not in asthma, but may help in HTN), Botox, petasites/butterbur, propranolol, timolol, topiramate, valproic acid
  • Triptans are good for an acute migraine.
  • Butorphanol has an intranasal route, good for nausea and vomiting

Tension Headaches:

Treatment: APAP, NSAID, ASA, treat depression and anxiety
Prophylaxis: Tricylic antidepressants, Botox

Cluster Headaches:

Treatment: triptans, oxygen, intranasal lidocaine, octreotide and 10% cocaine
Prophylaxis: verapamil, melatonin, suboccipital injection of betametasone, lithium (~0. 3 mmol/L, subtherapeutic, dose for bipolar = 0.8 – 12)

Filed Under: Neurology

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acid base acidosis acute coronary syndrome alkalosis analgesics anaphylaxis aortic dissection arrhythmia Beta-Blockers biostatistics blood pressure cardiac markers CHA2DS2-VasC cocaine COVID-19 diabetes diabetes inspidius Guidelines heart failure Heparin hypersensitivity hypertension hypovolemic shock intubation ionotropes journal club lipids LMWH medication safety morphine conversions myocardial infarction needs work NOAC NSTEMI obstructive shock pharmacoeconomics pheochromocytoma pressors reference materials right mi sedation septic shock shock STEMI Updated 2020