Central Nervous System

Question 1

2.1 migraine and headache

Symptoms?
Referral?
OTC?
Advice?

Answer 1

Symptoms:
1. cluster headache
• occurs in clusters
• intense pain in one eye
2. Sinus headache
• occurs when nose becomes blocked
3. Tension headache
• constant ache that feels like a tight-band
around the head 4. Migraine
• unilateral throbbing pain
• n+ v
• photosensitivity
• migraine with or without aura
• acute triggers
referral: sumatriptan:
• 1st attack in 50 +
• 4 attacks in a month
• > 24 hour headache
• symptoms have changed
• avoid in liver or renal impairment
• cardiovascular disease
• epilepsy
Headache:
• unresponsive to analgesics in 1 day
• taking combined contraceptives with
migraine-type headache
• recurring headache
• neck stiffness
• children under 12
• severe headache >4 hours
• recent trauma/injury
• increasing severity or frequency
• severe deep pain - worse when lying
down
OTC products:
• simple analgesics - paracetamol,
ibuprofen, aspirin
• analgesics with codeine/dihydrocodeine

Anti-emetics for migraines
• prochlorperazine - buccastem M
• buclizine (migraleve pink)
POM to P
• sumatriptan 18-65 years
OTC licensing: migraine with or without aura
1. previously tried simple analgesics
2. established pattern
3. previously diagnosed
How to take:
• one 50mg tablet ASAP after migraine
onset
• do not take a second dose for the
same attack
• a second dose can be taken after 2
hours if migraine recurs - max 2 in 24 hours
Advice:
• daily use of analgesic cause chronic
daily headache
• codeine/dihydrocodeine causes
addiction

Question 2

2.2 insomnia

Answer 2

symptoms:
• difficulty initiating sleep
• difficult maintaining sleep
• early morning waking
• poor sleep quality
referral:
• chronic insomnia > 3 weeks
• suspected depression
• under 16 years
• medication - MAOIs, fluoxetine,
phenytoin, steroids, theophylline
OTC products:
• 16+ diphenhydramine (nytol)
• 16 + promethazine hcl (sominex,
phenergan)
• take at bedtime
Advice:
• do not use mobile, computers or watch
TV before bed
• establish a sleep routine
• avoid napping during the day
• relax before bedtime, warm baths, listen
to calm music
• avoid caffeine, alcohol, nicotine,
exercise and heavy meals a few hours before bed

Question 3

2.3 motion sickness

Answer 3

symptoms:
• nausea and vomiting
• pale skin
• cold sweats
• dizziness
• triggered by travel by car, air or sea
referral:
• symptoms continue after stopping travel
• taking other anticholinergic drugs e.g.
TCAs, phenothiazines
OTC products:
• choice depends on the length of journey
due to duration of action
• causes drowsiness
antimuscarinic drugs
journey under 4 hours = hyoscine
• 10+ (kwells)
• 4+ (wells kids)
• 3+ (joy-ride)
Take up to 30 mins before
journey over 24 hours
• hyoscine patches
• 10 + - lasts 72 hours
• takes 5-6 hours or evening before
contraindicated with glaucoma and prostate enlargement

Antihistamines
journey 4-8 hours
• 5+ cinnarizine lasts 8 hours
(sturgeon) - take 2 hours before
• 2+ promethazine lasts 6-8 hours
(phenergan) - take the night before
alternatives
• acupressure wristbands - sea-band
• ginger herbal supplements
• suitable for pregnant or
breastfeeding women, drivers, and those who cannot take anticholinergic drugs
Advice:
• keep still
• look at a stable object
• fresh air
• relax