management consists of three strategies: general, abortive, and prophylactic.
general measures
- educate the family
- document occurrences on a calendar to evaluate effectiveness of treatments
- identify precipitating factors
- arrange for school professional to administer medicine if child is school-aged
abortive
- coping mechanisms: hot/cold shower, rest in a quiet, dark room with cool cloth applied to forehead
- serotonin agonists: triptans [sumatriptan]
- activates 5-HT1b and 5-HT1d receptors, which inhibit release of vasodilatory peptides, promoting vasoconstriction
- treats vasospasm
- avoid concurrent use of SSRIs due to serotonin syndrome
- analgesic at onset: NSAIDs [ibuprofen, naproxen], acetaminophen
- try to avoid chronic, daily use
- watch out for rebound headaches that can be confused for migraines
- antiemetics if nauseous: D2 antagonists [metoclopramide, phenothiazines]
- rectal administration is better tolerated than oral
prophylactic
- avoid triggers
- recommended if headache frequency > 4 times a month
- beta blockers: propanolol
- risk of stroke
- anticonvulsants: valproic acid, topiramate, gabapentin, phenobarbital, phenytoin
- increase GABA inhibition in cortex
- antidepressants: tricyclics [amitriptyline]
- watch out for anticholinergic effects
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Dear Med Student : yr notes very useful . I work directly for the president here . I am addicted to painkillers (fiorinal, other barbiturates). Just cannot find any place near Toronto Canada that can help me (I mean a place that does not have a long waiting list) . I need to detox ; hv tried so hard on my own, and for years. I keep going back to daily ABUSE of the painkillers. If you are able to point me to some place ( a URL or just the name) I wd be so very thankful .
If you are not in Canada , I apologize for troubling you.
My best wishes in yr studies and future career in Medicine. All the best, Leila S
nice work, guy