Ch 4.1 - Headaches

Question 1

What are the most common headaches to be encountered in community pharmacy?

Answer 1

tension headaches
migraine
sinusitis

Question 2

Describe symptoms of tension headache

Answer 2

pain often at base of head and upper part of neck - sometimes extends to over the head/top of eyes

pain - dull nature

Question 3

Describe symptoms of migraine

Answer 3

unilateral, affecting one side of head esp. over the forehead

Question 4

What are the two types of migraine?

Answer 4

Without aura (common migraine) - 75% of cases

Without aura (classic aura)

Question 5

Describe a classic migraine? Diagnostic pointers?

Answer 5

Often associated with alterations in visions before an attack = prodromal phase

At least three of the following characteristics:
One or more transient focal neurological aura symptoms
Gradual development of aura symptoms over 4 min or several symptoms
in succession
Aura symptoms lasting 4–60 min
Headache following or accompanying aura within 60 min

Question 6

Describe a common migraine. Diagnostic pointers?

Answer 6

There is no prodromal phase (no aura), both sides of the head may be affected

Attacks lasting 4–72 h
At least two of the following headache characteristics:
Pulsating/throbbing
Pain of moderate to severe intensity
Pain aggravated by movement
Unilateral pain

At least one associated symptom:
Nausea and/or vomiting
Photophobia and phonophobia

Question 7

What is Chronic daily headache (CDH) defined as?

Answer 7

a headache that is present on most days i.e. more than 15 days a month, typically occurring over a 6 month period or longer

Question 8

What are the symptoms of cluster headaches?

Answer 8

number of headaches
one after the other - daily episodes of
pain over 2–3 months and then remission for up to 2 years

Each episode of pain can
last from ½h to 3 h and the pain is usually experienced on one side of
the head, in the eye, cheek or temple

Question 9

What is temporal arteritis and who does it usually affect?

Answer 9

arteries in the temples become inflamed - elderly

Question 10

What are the signs and symptoms of temporal arteritis?

Answer 10

arteries may appear red and are
painful and thickened to the touch.

severe frontal
or temporal headache that persists and is associated with a general
feeling of being unwell

REFFERAL

Question 11

If temporal arteritis treatment is delayed what can it lead to?

Answer 11

blindness, because the blood vessels to the eyes are also

affected by inflammation

Question 12

When to refer someone with a headache? (10)

Answer 12

1. Headache associated with injury/trauma
2. Severe headache of more than 4 h duration
3. Suspected adverse drug reaction
4. Headache in children under 12
5. Severe occipital headache (across the back of the head)
6. Headache that is worse in the morning then improves
7. Associated drowsiness, unsteadiness, visual disturbances or vomiting
8. Neck stiffness
9. Frequent migraines requiring prophylactic treatment
10. Frequent and persistent headaches

Question 13

What are the pharmacists choice of treatment for headache and considerations about formulation

Answer 13

Oral Analgesics - aspirin, paracetamol, ibuprofen

often combined with codeine, dihydrocodeine, doxylamine and caffeine

Dispersible - peak blood levels achieved 30min

Traditional tablet - 2 hours