CNS OTC - Migraine Flashcards
Define migraine.
Headache disorder. Characterised by severe headaches (commonly but not always unilateral, described as throbbing or pulsating) with associated symptoms e.g. photophobia.
What are the key features of migraine with aura? (5)
Neurological symptoms
Alterations in vision (prodromal phase)
Tingling/numbness
N+V
Relief from lying in a darkened room.
3x more common in women than men.
What are the key features of migraine without aura? (4)
Absence of neurological symptoms
No prodromal phase
Both sides of head may be affected.
GI symptoms can occur.
What triggers can cause migraine? (5)
Dietary
Hormonal
Physical
Environemental
Psychological
What are the 3 phases of migraine? (3)
Prodromal phase
Attack
Resolution/ postdromal phase
What are the initial prodromal symptoms of migraine? (4)
Mood variation
Yawning
Food Cravings
Fluid Retention
What are the aura symptoms of migraine? (6)
Lasts < 1 hr:
Flashing lights/arc of light
Blind spot
Numbness and tingling sensation
Weakness
Clumsiness
What are the symptoms during a migraine attack? (6)
Severe headache
Throbbing/pulsating pain
Unilateral
N+V
Photophobia
Phonophobia
What are the symptoms during resolution of a migraine? (2)
Symptoms slowly fading.
Headache becoming less severe.
What are the post-dromal symptoms of migraine? (3)
Hangover effect
Fatigue
Depressed mood
Migraine associated with high risk of depression, BAD, AD and panic disorder.
What are the OTC tx options for migraine?
Analgesics: Schedule 15 products (PAI)
Anti-emetics: Buclizine (pink Migraleve), Prochlorperazine (Bucastem M) - N+V
Triptans (selective 5-HT agonists) - Sumatriptan. Acts on headache, photophobia, phonophobia and nausea.
What is the supply criteria for Sumatriptan? (7)
Migraine diagnosed by doctor/pharmacist.
Simple analgesia tried and ineffective +
Aged 18-65 yrs.
Established and stable pattern of migraine with or without aura.
Migraine for at least 1 yr.
Had at least 5 or more attacks.
What precautions do you need to consider before supplying sumatriptan?
Concomittant use: SSRI/SNRI, St John’s Wort, COC.
Heart disease risk factors (C/I in px with 3 or more risk factors e.g. diabetes, high cholesterol, smoking/use of NRT)
What are the c/i of sumatriptan? (6)
< 18 or > 65 yrs.
Pregnant/breastfeeding
CVD or HPT and those with 3 or more CV risk factors, Hx of stroke, renal or hepatic impairment.
Epilepsy or Hx of seizures
MAOI in last 2 weeks
Known triptans allergy
Explain how to use sumatriptan. (5)
1 tablet taken ASAP at first signs of a migraine headache.
Symptoms return after initial relief - 2nd tablet may be taken after 2 hrs.
Max 2 tablets in 24 hrs and no more than 2 tablets to be taken for same attack.
If 1st tablet doesn’t give relief then 2nd shouldn’t be taken. (It’s a headache not migraine)
Not to take as prophylactic treatment
What counselling is given for migraine? (6)
Avoid trigger factors
Immediate analgesic use
Sleep
Dark and quiet environment
Hot/cold compress
Prescribed tx and prophylaxis
