Headache

Question 1

What are the symptoms of migraine ?

Answer 1

intense throbbing headache on one side of the head
nausea and vomiting
sensitivity to light or sound

Question 2

What is aura ?

Answer 2

temporary warning symptoms before migraine

Question 3

Aura symptoms ?

Answer 3

Visual disturbances
numbness or pins and needles: starting in one hand, moves up arm before affecting face, lips and tongue
Dizzy, off-balance
difficulty speaking

Question 4

What drugs are used in treatment of migraines ?

Answer 4

5 HT1 receptor agonists ( triptan)
Ergot alkaloids rarely used:
Nsaids: tolfenamic acid ( licensed to treat acute migraine attacks)

Question 5

Name all 5 HT1 receptor agonists ( triptans ) ?

Answer 5

Almotriptan
Eletriptan
Frovatriptan
Naratriptan
Rizatriptan
Sumatriptan ( can also treat cluster headaches)
Zolmitirptan ( can also treat cluster headaches)

Question 6

What drugs are used for prophylaxis of migraine ?

Answer 6

• propranalol, atenolol, metoprolol, nadolol, timolol
• antiepiletic drugs: topiramate, sodium valproate, gabapentin
• tricyclic antidepressants, valproic acid
• pizotifen ( antihistamine serotonin receptor antagonist; limited value and causes weight gain

Question 7

What is first and second line treatment in acute migraine attacks ?

Answer 7

first line: simple analgesic: better soluble and dispersible
second line: Sumatriptan: if frequent prolonged attacks despite treatment then can combine with NSAIDs

Question 8

What is a particular side effect of ergotamine?

Answer 8

peripheral vasospasm

Question 9

Patient counselling for ergotamine ?

Answer 9

stop if numbness or tingling of extremities occur. Avoid in cerebrovascular and cardiovascular disease

Question 10

What is criteria for treatment of migraine prophylaxis ?

Answer 10

• suffer at least two attacks a month
• increasing frequency of headaches
• significant disability despite treatment for migraine attacks
• cannot take suitable treatment for migraine attacks

Question 11

How does 5 HT1 receptor agonists work ?

Answer 11

Act on 5-HT 1d and 5-HT 1b present on cranial arteries and veins to cause vasoconstriction

Question 12

How should triptans be taken ?

Answer 12

take one dose ASAP after onset, followed by a second dose at least 2 hours later ( 4 hours in naratriptan ) if migraine recurs. Do not take the second dose for the same attack

Question 13

Side effects of triptans ?

Answer 13

Coronary vasoconstriction ( raises BP can cause ischaemia or anaphylaxis

Question 14

Triptans contraindications ?

Answer 14

ischaemic heart disease, previous myocardial infarction, coronary vasospasm, prinzmetals angina, uncontrolled or moderate severe hypertension, peripheral vascular disease, previous stroke/TIA

Question 15

Triptans shouldn’t be used for what type of migraines ?

Answer 15

not for hemiplegic (one side of the body goes numb ) basilar or optalmoplegic migraines ( pain around the eye, causes brief moments of blindness )

Question 16

How should patients be counselled when taking triptans?

Answer 16

stop if intense tingling, heat, heaviness, pressure or tightness in any part of the body occur.