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Headaches-Migraines Tensions And Clusters PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Headaches: Migraines, Tensions, and Clusters” by Mikael Jones, PharmD, BCPS.

This medical PowerPoint presentation is about headaches, a common ailment that can have a significant impact on a persons daily life. There are several types of headaches, including migraines, tension headaches, and cluster headaches.

Migraines are characterized by a severe, throbbing pain on one or both sides of the head. Migraines are often accompanied by other symptoms, such as sensitivity to light, sound, or smell, nausea, and vomiting. Migraines can last for several hours to several days and can be triggered by various factors, such as stress, hormonal changes, and certain foods.

Tension headaches are the most common type of headache, and they typically cause a dull, aching pain on both sides of the head. Tension headaches are often caused by stress, poor posture, and eye strain. They can last anywhere from a few hours to several days and are usually not accompanied by other symptoms.

Cluster headaches are a rare type of headache that occur in clusters or groups, usually on one side of the head. They cause a sharp, stabbing pain that can be excruciatingly painful. Cluster headaches typically last for 15 minutes to 3 hours and can occur several times a day for weeks or months at a time. Cluster headaches are often accompanied by other symptoms, such as eye watering, nasal congestion, and facial sweating.

Its important to note that if you experience sudden or severe headaches, or if you have a headache that is different from your usual headaches, you should seek medical attention right away. A healthcare provider can help you determine the cause of your headaches and recommend appropriate treatment options.

Tags : headaches, migraines, tension headaches, cluster headaches, Neurology, Neurology PowerPoint presentation

Published on : Jun 20, 2023 | Views : 900 | Downloads : 1

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Slide 1-

Headaches: Migraines, Tensions, and Clusters! Oh My! Mikael Jones, PharmD, BCPS
Slide 2-

Headaches Most common complaint encountered by health care professionals ~18 million outpatient visits annually International Headache Society classification system Numerous types and causes of headache Primary Headache Disorders Secondary Headache Disorders
Slide 3-

Headaches Primary headache disorders Migraine Cluster Tension
Slide 4-

Migraines:Clinical Presentation Prodromal Symptoms Photophobia/phonophobia Aura Visual or sensory/motor symptoms Headache Gradual onset with variable length Unilateral , throbbing in frontotemporal region Nausea/vomiting
Slide 5-

Migraine Headaches Pathophysiology Vascular Theory Intracerebral arterial vasoconstriction Followed by reactive extracranial vasodilation Neurovascular Dysfunction Theory Trigeminovascular system Auras Vascular vs neuronal dysfunction
Slide 6-

Neurovascular Dysfunction Theory Vasodilation of intracranial extracerebral blood vessels Activation of perivascular trigeminal nerves Release of neuropeptides Neurogenic inflammation Pain signal Transmission Migraine pain Associated symptoms
Slide 7-

Neurovascular Dysfunction Theory
Slide 8-

Pharmacologic Sites of Action Regulation of trigeminovascular system Noradrenergic Serotonergic Neuropeptide
Slide 9-

Pharmacology of Serotonin Serotonin (5-hydroxytryptamine or 5-HT) Multiple MOA in the body Seven 5-HT receptors described Effects on many organ systems Nervous System Airway Cardiovascular Gastrointestinal
Slide 10-

Pharmacology of Serotonin Synthesized from L-tryptophan Metabolized by monoamine oxidase Serotonergic neurons regulate Mood Sleep Appetite Perception of pain Vomiting Temperature/Blood pressure regulation
Slide 11-

Pharmacology of Serotonin
Slide 12-

Pharmacologic Targets for Migraines Agonistic action on 5-HT1b receptors Vasoconstriction of meningeal blood vessels Agonistic action on 5-HT1d receptors Inhibits release of neuropeptides Interrupt pain signal transmission Suppression of underlying neuronal dysfunction
Slide 13-

Pharmacologic Agents for Treatment of Migraines Abortive therapies Ergot alkaloids Serotonin agonists NSAIDS Combination analgesics Butorphanol Metoclopramide Prophylactic therapies Beta blockers Antidepressants NSAIDS Valproic Acid Methysergide Calcium Channel blockers
Slide 14-

Ergot alkaloids Derived from a fungus that infects grain Ergotism/ St. Anthony’s fire LSD “Dirty” receptor binding Binds to 5-HT, - and -adrenergic, and dopamine receptors Agonist, Partial agonist, and antagonist effects
Slide 15-

Ergotamine/DHE Ergotamine tartrate PO, SL, PR routes Products contain caffeine to increase absorption Dihydroergotamine (DHE) IM, SQ, Nasal Spray
Slide 16-

Ergotamine/DHE 5-HT1 receptor agonists Side effects Nausea/vomiting Chest tightness Separate from triptans by >24 hours Contraindications Renal and/or hepatic failure Coronary, cerebral, peripheral vascular disease
Slide 17-

Serotonin Receptor Agonists Selective agonists of 5-HT1b/5-HT1d Vasoconstriction of pain producing intracranial blood vessels Inhibition of vasoactive peptides release Interruption of pain signal transmission 7 agents currently available Various dosage forms Different pharmacokinetics Repeat dosing/Max dose
Slide 18-

Serotonin Receptor Agonists Sumatriptan (Imitrex®) Tablets, SC injection, Nasal Spray Zolmitriptan (Zomig®) Tablets, Orally disintegrating, nasal spray Rizatriptan (Maxalt®) Tablets, Orally disintegrating
Slide 19-

Serotonin Receptor Agonists Naratriptan (Amerge®) Tablets Almotriptan (Axert®) Tablets Frovatriptan (Frova®) Tablets Eletriptan (Relpax®) Tablets
Slide 20-

Serotonin Receptor Agonists
Slide 21-

Serotonin Receptor Agonists
Slide 22-

Serotonin Receptor Agonists Adverse effects Fatigue Dizziness Flushing/warm sensation Chest symptoms Cardiac events Stroke Increased blood pressure
Slide 23-

Serotonin Receptor Agonists Contraindications Ischemic heart disease Uncontrolled hypertension Cerebrovascular disease Peripheral Vascular disease
Slide 24-

NSAIDs & Analgesics Prevent neurogenically-mediated inflammation Inhibition of prostaglandin synthesis Short-acting>Long-acting Combination products Butalbital Narcotics Midrin Acetaminophen/Isometheptene/Dichlor-alphenazone
Slide 25-

NSAIDS & Analgesics Aspirin Acetaminophen Ibuprofen Naproxen Diclofenac Midrin APAP/ASA/Caffeine Excedrin® ASA/butalbital/caffeine Fiorinal® APAP/Butalbital/caffeine Fioricet®
Slide 26-

NSAIDs & Analgesics Adverse Effects Dyspepsia Nausea/vomiting Drowsiness (butalbital/midrin®) Addiction (butalbital/midrin®) Precautions Ulcer disease Renal disease ASA hypersensitivity
Slide 27-

Opiates “Rescue” narcotics Meperidine Butorphanol (Nasal Spray) Oxycodone Adverse Effects Addiction Rebound Headache N/V Constipation
Slide 28-

Antiemetics Adjunctive therapy Prevent/treatment migraine-induced n/v Common Agents Metoclopramide Chlorpromazine Adverse Effects Extrapyramidal side effects Drowsiness
Slide 29-

Prophylaxis Therapy Prevent Migraine occurrence Reduce frequency/severity/duration Consider for the following patients Significant disability Attacks >2/week Acute therapy ineffective/contraindicated
Slide 30-

Beta-Blockers Antagonist of β-adrenergic receptors Raise migraine threshold Modulate serotonergic neurotransmission Adverse Effects Fatigue Sleep Disturbances Bradycardia Hypotension Impotence
Slide 31-

Beta-Blockers Precautions CHF Peripheral vascular disease Asthma Depression Diabetes Propranolol Lipophilic Atenolol Hydrophilic Nadolol hydrophilic Metoprolol β1-selective
Slide 32-

Antidepressants Tricyclic antidepressants (TCAs) Antagonism of 5-HT2 receptors on cerebral vessels Suppression of serotonergic neuronal activity in brain stem Selective Serotonin Reuptake Inhibitors (SSRIs) Less effective than TCAs
Slide 33-

Antidepressants Side effects (TCAs) Anticholinergic Weight gain Orthostatic hypotension Cardiac toxicity Precautions Benign prostatic hyperplasia Glaucoma Suicide risk
Slide 34-

Antidepressants TCAs Amitriptyline Doxepine Imipramine SSRI Fluoxetine
Slide 35-

Valproic acid Inhibition of serotonergic neurons Facilitate GABA neurotransmission Depakote (divalproex) ER vs DR Adverse Effects N/V Tremor Weight gain Blood dyscrasias Hepatotoxicity
Slide 36-

Other anticonvulsants Topiramate Gabapentin
Slide 37-

Methysergide Ergot alkaloid 5-HT2 receptor antagonist Stabilize serotonergic neurotransmission Block neurogenic inflammation Adverse Effects Retroperitoneal, endocardial, pulmonary fibrosis Long-term use; rare GI intolerance
Slide 38-

Methysergide Adverse Effects Insomnia Hallucinations Claudication Muscle cramps Contraindications Renal and/or hepatic failure Coronary, cerebral, peripheral vascular disease
Slide 39-

Calcium Channel Blockers Verapamil Inhibition of 5-HT release Adverse effects Constipation Hypotension Bradycardia AV block
Slide 40-

NSAIDs Prevent neurogenically-mediated inflammation Inhibition of prostaglandin synthesis Menstrual migraine
Slide 41-

Cluster Headache Activation of trigeminovascular system Neurogenic inflammation in cavernous sinus Hypothalmic dysfunction Modulated by serotonergic neurons Abortive/Prophylactic therapy
Slide 42-

Cluster Headache Attacks occur in clusters 2weeks to 3 months Pain free intervals from months to years Excruciating/penetrating pain Unilateral in orbital, supraorbital, temporal locations Conjunctivial injection/lacrimation Nasal congestions/rhinorrhea Facial tenderness or edema
Slide 43-

Oxygen Cerebral vasconstriction 100% O2 at 7-10L/min for 10-15 min No adverse effects
Slide 44-

Ergots/Triptans DHE/Ergotamine Injection route preferred Ergotamine has been used as prophylaxis Sumatriptan SC/intranasal dosage forms Contraindication Monitoring parameters
Slide 45-

Lithium MOA: Unknown for headaches Adverse Effects Tremor Lethargy N/D Abdominal discomfort May cause non-cluster headaches Precautions Renal/Cardiovascular disease Dehydration Diuretic use
Slide 46-

Other agents Verapamil Methysergide Corticosteroids Prednisone 40-60mg/day tapered over 3 weeks Not for long-term use
Slide 47-

Tension Headaches Headache pain Muscular/myofacial in origin Increased muscle hardness Mild to moderate pain Tightness, pressure, dull ache Band extending bilateral back from forehead to occiput Radiate to neck muscles
Slide 48-

Treatment NSAIDs/Acetaminophen Reduce pain related to headache Can use combination products Amitriptyline Prophylactic agent
Slide 49-

Rebound Headaches Self-sustaining headache-medication cycle Daily headache superimposed on original headache Analgesics, triptans, ergots, opioids Must discontinue agent and allow headache cycle return to normal Limit abortive agents ~2 per week
Slide 50-

Questions?