CNS/MSK OTC Flashcards
How is pain treated?
By OTC analgesias
- Paracetamol
- Ibuprofen
- Aspirin
- Codeine/dihydrocodeine
- Topical formulations
What is a migraine?
A complex neurological condition with a wide variety of symptoms such as nausea, vomiting, photophobia, phonophobia
Female to male 3:1 incidence ratio
What is a theory of migraines?
Vasodilation of blood vessels in brain
What is the classification of migraines?
Migraine without aura
Migraine with aura
What is a migraine without aura?
Recurrent headache disorder
Lasts 4-72 hours
Unilateral, pulsating, severe pain, aggravated by physical activity
Relief: lying in a dark room
List some migraine triggers
- Diet: crash diet, red wines, cheese
- Environmental: smoking, bright lights, screen, loud noise
- Psychological: depression, anxiety, stress
Medicines: COC and HRT
Other: menstruation, menopause
What is a migraine with aura?
Transient, unilateral neurological symptoms of visual, sensory or other CNS
Aura occurs 5-60 minutes before headache
Visual aura: zigzag lines, flashing lights
Sensory: tingling in lips, fingers, difficulty speaking
What are the treatment options for migraines?
- Simple analgesia (avoid recommending codeine/di)
- Anti-emetics
Migraleve pink
Buccastem M Buccal (prochlorperazine 3mg) CI in epilepsy, liver, glaucoma - Migraine specific (5-HT1 agonists or ‘triptans’)
How do 5-Ht1 agonists work?
Imitation of the action of 5-HT which causes the dilated blood vessels to constrict
Sumatriptan OTC (imigran recovery) 18-65
History of 5/more in last year
30-60 minutes to work
When to be careful with sumatriptan?
Interactions MAOI, SSRI/SNRI, St John’s wort
Heart disease
Pregnant/breastfeeding
>50 first migraine
Failed treatment
COC
Migraine lasts over 24hr
How to take sumatriptan
- One 50mg tablet asap
- Start of headache and not aura unless they occur simultaneously
- Second dose can be taken 2hr after if symptoms come back
- No more than 2 tablets in 24hrs or for same attack
Benefit of prescribed treatment
- Improved QOL
- Reduce frequency, severity and duration of attacks
Counselling advice for migraines
- Keep headache diary
- Immediate use of simple analgesia
- Dark and quiet environment
- Good sleep hygiene
- Diet and fluid intake
- COCs
- Cold compress
What is a TTH?
Tension type headache (most common type)
Bilateral
Differentiation of TTH
Not aggravated by physical activity
No nausea/vomiting
No photophobia/phonophobia
Relieved by simple analgesics
What are the causes of a TTH?
Anxiety, screen time, poor sleep, poor posture, stress
Treatment for TTH
Paracetamol/ibuprofen
Syndol
Avoid codeine where possible
Counselling advice for TTH
- Alleviate stress
- Check sleep hygiene
- Advice on posture
- Exercise
- Regular breaks from screens
- Acupuncture
What is sinusitis?
Inflammation of the paranasal sinuses (swelling of the mucosal lining)
Triggered by URT infection
Symptoms of sinusitis?
- Unilateral
- Facial pain/pressure/headache
- Throbbing & tender to touch
- Blocked nose (congestion), runny nose (nasal discharge)
- Loss of smell
- Fever
Treatment of sinusitis
- Analgesia: paracetamol/ibuprofen
- Intranasal decongestant max 7 days use
- Nasal irrigation w/saline
- Refer if signs of infection (fever, severe pain, discoloured discharge)
What is a cluster headache?
Severe unilateral pain which comes on suddenly
Localised in/around eye
15mins - 3 hours
What are the associated symptoms of cluster headaches?
- Nasal congestion
- Facial flushing/sweating
- Miosis
Refer to GP
What are the red flags of a headache?
- Migraine with COC
- Headache with temp >38
- Frequent treatment failure
- Lasting over 4hrs
- Children under 12
- Neck stiffness
