Headache Migraine

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Headache & Migraine: 

Headache and Migraine Brooke Y. Patterson, PharmD, BCPS Adjunct Professor Research College of Nursing


Epidemiology Migraine headaches affect up to 30% of Americans A family history of migraines increases a patient’s chance of having migraines Immediate family history positive in 60% of patients Women are affected 3 times more than men


Pathophysiology Neurovascular reaction Several theories Vasodilatory Neurological Neurogenic dural inflammation

Classification of Headaches: 

Classification of Headaches Vascular headache Migraine With aura (15%) Without aura (85%) Cluster Non-migraine vascular Tension-type HA HA due to organic cause Disorders affecting cranial structures

Migraine with Aura: 

Migraine with Aura At least 2 attacks Aura must exhibit at least 3 of the following: Fully reversible Gradual onset Duration less than 60 minutes HA follows aura with a free interval of less than 60 minutes Normal neurological exam with no evidence of organic disease International Headache Society Definition of Migraine with Aura

Migraine without Aura: 

Migraine without Aura At least 5 headaches lasting 4-72 hours Headache has at least 2 of the following: Unilateral location Pulsating quality Moderate or severe intensity Aggravated by routine physical activity At least 1 of the following during HA: Nausea/vomiting Photophobia and phonophobia Normal neurological examination with no evidence of organic disease International Headache Society Definition of Migraine without Aura

Common Headache Triggers: 

Common Headache Triggers Stress Muscle tension Hormonal changes Depression Sleep disturbances Poor posture Skipping or delaying meals Certain foods or food additives Alcohol Caffeine withdrawal High BP Eyestrain or glare Sinus problems Bright lights or loud noises Certain kinds of weather

Therapy of Migraine Headache: 

Therapy of Migraine Headache Lifestyle changes Avoid triggers Sleep Ice packs to head Drug therapy


Acetaminophen Effective for mild to moderate migraine 1000mg PO at first sign of migraine


NSAIDs DOC in headache (not migraine) Used as an alternative in patients who cannot take triptans or ergotamine Used in mild to moderate disease Ibuprofen 800mg at onset Ketoprofen 75mg at onset Naproxen 750mg at onset, may repeat dose of 250mg every 30-60 minutes (max 1500mg)


Triptans Drug of choice in migraine headache Each patient responds differently to triptans—may have to try several All triptans are pregnancy category C Should only be used if potential benefits justify potential risk Contraindicated in ischemic HD, uncontrolled HTN


Ergotamine Less expensive than triptans Not effective once migraine attack has already been established Must be taken at first sign of attack Potent vasoconstrictor Cyanotic extremities possible Ischemic bowel disease Renal dysfunction Should NOT be given to pregnant women Oxytocic properties


Ergotamine Several products available All oral tablets are co-formulated with caffeine SL tablets are ergotamine only To avoid rebound HA, ergotamine should not be used more often than twice in 1 week Preferably NOT on consecutive days

Migraine Prophylaxis: 

Migraine Prophylaxis Patients have 2 or more migraine attacks per month. Beta-blockers Propranolol is DOC Antidepressants SSRIs DOC for mixed HA syndrome (tension and migraine)

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