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Pharmacotherapeutics Theory 2 > Headache > Flashcards

Headache Flashcards

1
Q

What is a Migraine?

A

Unilateral, pulsating headache frequently associated with nausea/vomiting, gastric stasis, photophobia and phonophobia – some patients may experience aura

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2
Q

What are the Phases of a Migraine?

(Characterisation and Duration)

A
  • Prodrome
    • Changes in mood, energy levels, behaviour and appetite
    • Hours to days before headache
  • Aura
    • Visual disturbances, dizziness, paraesthesia, impaired speech
    • 15 min – 1 hr duration
  • Headache
    • Pulsating, unilateral, photophobia, phonophobia, nausea, vomiting
    • 4 hr – 72 hr duration
  • Postdrome
    • Weakness, fatigue, tenderness of head, neck and stomach
    • Hours – days after headache resolution
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3
Q

What is a Tension Headache?

How long does it last?

A
  • Bilateral band of tightness/pressure or heaviness
  • Lasts minutes or days
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4
Q

What are the characteristics of a Medication Overuse Headache?

A
  • Excessive use of medication
  • Nature of headache can be both migraine and tension headache-like
  • Change in headache pattern/nature
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5
Q

What are the symptoms that are warning signs of potentially more sinister causes of headache

New onset headache in a person

A
  • Having seizures but not an epileptic
  • Pregnant or post-partum
  • Taking an anticoagulant (warfarin/DOAC)
  • > 50 years
  • Young and obsess
  • Hx of cancer or immunodeficiency
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6
Q

What are the symptoms that are warning signs of potentially more sinister causes of headache

Headache associated with

A
  • Fever or neck stiffness
  • Head injury
  • Person being woken from sleep
  • Stroke-like symptoms or signs
  • Symptoms worsening by coughing or physical activity
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7
Q

How can headache occurrence be minimised?

A
  • Avoidance of triggers will help to minimise headache occurrence
  • Keeping a headache diary can be helpful in assisting patients to understand their migraine triggers
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8
Q

What are the Triggers of Migraines?

A
  • Menstruation
  • Weather
  • Stress
  • Red wine (and other tyramine containing foods such as aged cheese, yeast, MSG)
  • Hunger/skipping meals
  • Noise
  • Exhaustion
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9
Q

What are Menstrual Migraines triggered by?

A

Menstrual migraines are triggered by a decrease in oestrogen levels

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10
Q

How can Menstural migraines be managed?

A
  • Prophylactic treatment can be initiated a short time before the likely onset of migraine using either NSAIDs or topical oestradial gel
  • In some instances, patients may need to reduce the frequency of menstruation using COC to reduce frequency of withdrawal bleeds and therefore reduce the frequency at which the patient is at risk of developing a menstrual migraine
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11
Q

What does Migraine with Aura increased the risk of?

A
  • Migraine with aura increases the risk of stroke and that is further increased through the use of the COC
    • Use of COC in a patient with migraine with aura is contraindicated
    • Balance the desire to prevent migraine vs. potential risk of stroke
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12
Q

What Triptans have the lowest and highest lipophilicity?

A
  • Lipophilicity (lowest to highest): Sumatriptan, rizatriptan, zolmitriptan, eletriptan, naratriptan
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13
Q

What Triptans have the lowest and highest bioavailability?

A
  • Bioavailability (lowest to highest): Sumatriptan, zolmitriptan, rizatriptan, eletriptan, naratriptan
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14
Q

What is the onset of efficacy of the Triptans?

A
  • Onset of efficacy (mins) (fastest to slowest): Rizatriptan, Sumatriptan, zolmitriptan, eletriptan, naratriptan
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15
Q

What is the time to peak of the Triptans?

A
  • Time to peak (hrs) (fastest to slowest): Rizatriptan, Zolmitriptan, Sumatriptan, eletriptan, naratriptan
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16
Q

What is a major barrier to migraine treatment?

How can this be minimised?

A
  • A solid dosage form will sit in stomach and won’t get absorbed in migraine
  • This is a major barrier to treatment
    • Can be minimised through the selection of appropriate formulations (e.g. soluble aspirin) and through the use of antiemetics with prokinetic effects (metoclopramide)
17
Q

How are Triptans used in Migraine Recurrence?

What happens if migraine recurs?

A
  • Repeating a dose of triptan in a patient who hasn’t responded to the initial dose is unlikely to produce a response
  • If migraine recurs (and responded to initial dose), repeat dose
    • Rizatriptan, sumatriptan, zolmitriptan and eletriptan: repeat after 2 hours
    • Naratriptan: repeat after 4 hours (long t1/2 life)
18
Q

How do Medication Overuse Headaches occur?

What may some patients require?

A
  • Overuse of migraine treatments can lead to medication overuse headache (as some acute treatments are not always effective)
  • Some patients require prophylactic treatment
19
Q

What are non-drug treatments of headache?

A
  • Non-drug treatments are of significant value in tension headache and also migraine
    • Cold packs on forehead or back of skull
    • Hot packs over neck and shoulders
    • Neck stretching
    • Rest (avoid loud noises, lights, movement)
    • Hydration
20
Q

Does a Medication Overuse Headache occur in everyone?

A
  • Chronic overuse of analgesics does not cause increased incidence of headache in patients who don’t have a primary headache
    • E.g. patients taking regular analgesics for arthritis don’t show increased incidence of headache
21
Q

What is the Treatment Strategy of Medication Overuse Headache?

A
  • Withdrawal of overused drug (abrupt [opioids] or taper 4-6 weeks)
  • Initiation of preventative medication (particularly if migraine is the primary headache type – amitriptyline is the most common choice)
  • Strictly limit the use of triptans/ergots/NSAIDs for acute attacks
22
Q

What is Meningitis?

What is it caused by?

A
  • Inflammation of the meninges
  • Infection caused by viruses, bacteria and fungi
    • Most common organisms
      • Streptococcus pneumoniae
      • Neisseria meningitidis (meningococcal)
      • Listeria monocytogenes (in immunocompromised)
23
Q

What are the Signs and Symptoms of Meningitis?

A
  • Stiff neck
  • Headache
  • Photophobia
  • Fever (differentiation of meningitis from migraine)
  • Vomiting
  • Joint pain (differentiation of meningitis from migraine)
  • Fitting (differentiation of meningitis from migraine)
24
Q

What is Meningococcal Septicaemia characterised by?

A
  • Characterised by a rapidly evolving purpuric rash that doesn’t blanch under pressure
25
Q

Discuss Prophylaxis (Clearance) of Meningitis

A
  • Clearance of organism from someone who’s carrying it around
  • Among close contacts, individuals may be asymptomatically carrying the organisms in their nasopharynx
    • Prophylaxis aims to eradicate asymptomatic carriage of the organism in the network of contacts to prevent transmission to susceptible members of the groups

Pharmacotherapeutics Theory 2 (17 decks)

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