Headache Flashcards

1
Q

what questions would you ask a pt suffering from a headache?

A
  • Onset of action
  • Frequency and timing (menstrual cycle)
  • location of pain (cluster - unilateral in frontal and ocular areas, migraine - unilateral but changes from side to side, tension type - bilateral
  • severity of pain - subjective, throbbing, dull, piercing, boring, searing eye pain
  • Triggers - exertion, coughing, bending, food, menstruation
  • Attack duration - migraine lasts between a few hours and 3 days, tension-type headaches - few hours and several days, cluster lasts 2-3 hours
  • associated symptoms like fever - infections
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2
Q

What are the symptoms of tension-type headache?

A
  • Tightness or weight pressing down on their head and upper neck sometimes extends to the top of the head and back of the eyes
  • Not associated with neck stiffness or N/V
  • Headaches last 30minutes - up to 7 days
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3
Q

What symptoms are associated with migraines?

A

unilateral - affecting one side of the head, over the forehead
alterations in vision or tingling/numbness on one side of the body, in the lips, fingers or hands before an attack starts
N/V and photosensitivity
mood changes, poor concentration, food cravings
headache with or without aura
lethargic , tired, drained

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4
Q

How long do migraine attacks last for?

A

4-72 hours

average length is 24 hours

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5
Q

What can possibly trigger migraine attacks?

A

stress, diet, cheese, citrus fruits, chocolate
maintain a food diary
maintain regular sleep pattern
regular exercise

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6
Q

What can occur in pt that have a migraine with aura (classic migraine)?

A

blind spots, zig-zag lines, flashing or flickering lights
throbbing
pins and needles going up the arm
photophobia

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7
Q

What can be used to treat cluster headache?

A

sumatriptan or verapamil

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8
Q

What are the symptoms of meningitis?

A

severe generalised headache, fever, neck stiffness, N/V, purpuric rash, if a child has difficulty placing their chin on their chest and is running a temperature above 38.9 - urgent referral

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9
Q

When would you refer pts that present with headache?

A
  1. First migraine episode occurring over the age of 40
  2. Any headache that does not respond to OTC analgesics within a day
  3. Dull pain that is deep seated and severe and aggravated by lying down or worse in the morning - intracranial pressure derived from tumour
  4. headaches of increasing frequency and severity
  5. recurring headache can indicate medication-induced headache (overuse)
  6. any woman taking COC
  7. severe headache of more than 4 hours duration
  8. headache in children under 12 years
  9. neck stiffness
  10. headache following on from recent injury or trauma
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10
Q

What tx options can be given for pts with tension and migraine headaches?

A

Paracetamol
NSAIDS
Analgeic combo’s containing opioids e.g. codeine, dihydrocodeine - cant use in tension headaches
Sumatriptan

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11
Q

what are the side effects that can occur?

A
  • Daily use of analgesics can cause chronic daily headache so short term use only
  • drowsiness
  • respiratory depression
  • constipation
  • addiction
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12
Q

Name some OTC tx

A

Nurofen, Migraleve, Imigran, Paracodol, Solpadeine

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13
Q

What age group can migraleve and midrid? What side effects are associated? Interactions ?

A

> 12 years
Migraleve: dry mouth, sedation, constipation
interacts: alcohol, opioids, anxiolytics, hypnotics, antidepressants
glaucoma, prostrate enlargment

Midrid: dizziness, rash, avoid pts taking MAOIs - hypertensive crisis, avoid in pts taking BB and TCAs
careful in pts that have HTN and diabetes - short term is fine

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14
Q

How does sumatriptan work?

A

constricts the cranial blood vessels, stops the release of inflammatory neurotransmitters at the trigeminal nerve synapses and reduce pain signal transmission

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15
Q

What are the age restrictions of sumatriptan? when can it be used? when shouldnt it be used?

A

18-65 years
only use if clear diagnosis of migraine
dont use prophylactically

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16
Q

Which pts should sumatriptan (imigran) should not be given to?

A

those with cardiovascular conditions, HTN, peripheral vascular disease, liver or kidney disorders, neurological conditions, epilepsy

17
Q

what are the side effects of sumatriptan?

A

dizziness, drowsiness, warm, flushed or weak sensation of heaviness in any part of the body, pressure in the throat, neck chest arms legs, SOB

18
Q

When should sumatriptan be taken? can two tablets be taken?

A

one 50mg tablet should be taken ASAP after onset of attack.
A second dose may be taken after 2 hours if migraine recurs. If there is no response to the first tablet, a second tablet should not be taken for the same attack.

19
Q

What is the maximum dosage of sumatriptan?

A

max two tablets in 24 hours and the pt should not take any concurrent medication for migraines

20
Q

What is Buccastem? What is it used for?

A

Prochlorperazine
potent antiemetic - blocks dopamine receptors found in the chemoreceptor triggering zone

indicated for migraine sufferers >18 years one or two tablets daily

21
Q

what are the side effects that can occur with buccastem? interactions?

A

drowsiness, dry mouth, dizziness
alcohol - because it crosses BBB
also interacts with opioid analgesics, anxiolytics, hypnotics, antidepressants

22
Q

how would you administers the buccal tablet?

A

place between upper lip and gum
allow tablet to dissolve slowly
3-5 hours to dissolve completely
do not chew

23
Q

Peristalsis is reduced when a pt has a migraine attack, what can you recommend?

A

soluble or orodispersible tablets to maximise absorption