CNS - Migraine Flashcards
What are the 2 types of migraines?
1) Unliteral pulsating (severe enough to affect day to day activities)
2) with aura
With aura migraine symptoms?
Visual ( lights, flickering, lines, spots)
Sensory (pins + needles, numbness)
Unilateral migraine symptoms
Pulsating
Nausea vomiting
Photophobia
Migraine lifestyle advice?
AVOID Chocolate & Wine
Relax after stress
Hydrate, sleep, exercise
Headache diary to identify triggers
Acute treatment of migraines?
Aspirin, ibuprofen or Triptans (5HT1 agonist)
Migraines with aura when to take triptans?
Take triptan start of headache
NOT the AURA
How to take triptans?
Take 1 then repeat 2hrs after only if:
Inadequate response but a response from first dose was seen
**IF NOT HELPED AT ALL DO NOT TAKE 2nd DOSE
Which triptan second dose interval differs and how much by?
Naratriptan - 4hrs
If pt unable to taken aspirin, ibuprofen or triptan, what shall they take?
Soluble paracetamol - faster onset
Anti emetic used for migraines?
Metoclopramide/ Prochloroperazine
First line Migraine prophylaxis?
Propranolol
If pt is unable to use propranolol in migraine prophylaxis, what should they use?
Metoprolol or Nadalol
Alternative migraine prophylaxis med?
Amitriptyline also effective
If amitriptyline is not tolerated in migraine prophylaxis, what should they use?
Less sedating TCA
Specialist used drugs for migraine prophylaxis?
Sodium valproate
Pizotifen
Botox
Why should uncontrolled hypertension pt’s not use Triptans?
MOA of triptans constricts blood vessels
What newly added drug can now be used for migraine prophylaxis
Topiramate
What would be a sign for cluster headaches?
Unilateral intense pain in or around one eye
Cluster headache acute treatment?
Nasal Sumatriptan/Zolmitriptan
Or
Sc sumatriptan
Prophylaxis treatment in cluster headaches?
Verapamil
Lithium,
Prednisolone
or Ergotamine tartrate
Important signs to recognise symptoms of Trigeminal Neuralgia?
Severe Head pain, JAWS AND TEETH
ELECTRIC SHOCK
Trigeminal Neuralgia Treatment?
Carbamazepine
Tension Headache
Tight band around head = Bilateral thrombin pain
Tension headache treatment?
Paracetamol or ibuprofen
Subarachnoid Haemorrhage signs?
PAIN IN BACK OF NECK
KICKED IN BACK OF HEAD feeling
Subrachnoid Haemorrhage Treatment?
REFER TO A&E