Migraine Flashcards
Define migraine and associated symptoms
- Severe headache
- nausea, vomiting, visual disturbances and increased sensitivity to light or sound
- 2/3 of patients are women
- pain is of dull nature, throbbing and pounding
- two types of migraine
What are the 2 types of migraine?
Common - 75% = migraine without aura
Classic= migraine with aura
Treatment timescale of migraine
With treatment should resolve within 1 day
Symptoms of classic migraine
- unilateral, affecting ONE side of the head, especially over the forehead
- alterations in vision before attack starts (prodromal phase)
- Tingling/numbness on one side of the body, lips, finger, face or hands
- Nausea and vomiting
- bright lights hurt eyes during attack
- relief via lying down in dark room
Symptoms of a common migraine
- no prodromal phase (no aura)
- nausea and vomiting
- increased sensitivity like light, sound, smell
- headache may be one-sided, but both sides can be affected
- rest in a dark room
Referral criteria of migraines
- severe and >4hrs duration
- ADRs
- Children under 12yrs
- associated with head injury/trauma
- associated drowsiness, unsteadiness, visual disturbances, vomiting
- severe occipital pain across back of head and raised intracranial pressure i.e. deep-seated, severe and aggravated by lying down
- pain worse in morning and improved during the day
- nausea and vomiting
- neck stiffness
- frequent migraines or persistent headaches
- any woman taking the COC should be referred
- sudden severe pain at the back of the head- may signify subarachnoid haemorrhage (SAH) where a small blood vessel in brain leaks blood into CSF. May be due to high BP. Refer
Lifestyle advice for migraines
Stress
Certain foods
Hormonal changes (menses)
get eyes checked
Migraleve pink
APIs
symptoms
Co-codamol
Buclazine
Migraine
Migraleve pink contraindictions
In all paediatric patients (0 to 18 years of age) who undergo tonsillectomy and/or adenoidectomy for Obstructive Sleep Apnoea Syndrome due to an increased risk of developing serious and life-threatening adverse reactions (see section 4.4).
Head injury; in conditions in which intracranial pressure is increased; acute respiratory depression; obstructive bowel disorders and in patients at risk of paralytic ileus.
In women during breastfeeding (see section 4.6).
In patients for whom it is known they are CYP2D6 ultra-rapid metabolisers.
Migraleve tablets are contraindicated for children below 12 years of age
Migraleve pink populations and warnings
can only use for 3 days
can cause addiction
>12yrs only
Not suitable in pregnancy or breastfeeding
Treatments for migraine
Simple analgesics - Paracetamol, Ibuprofen
Migraleve (yellow/pink)
Imigran
Sumatriptan
Migraleve yellow
API and symptoms
co-codamol
Short term treatment of acute moderate pain which is not relieved by other analgesics
e..g migraine
Imigran nasal spray side effects
Dizziness
Drowsiness
sensory disturbance including parasthesia and hypoaesthesia
Dysgeusia/unpleasant taste
Imigran nasal spray API and what it does
Sumatriptan 10mg
Suppresses cough and helps you to sleep at night
warnings for imigran nasal spray
> 12yrs only
do not use in pregnancy or breastfeeding
Contraindications for imigran nasal spray
MI, IHD, coronary vasospasm, peripheral vascular disease
Symptoms suggestive of IHD
Not in history of TIA (transient ischaemic attack) or CVA (cerebrovascular accident)
Severe hepatic impairment
Hypertension
MAOIs - Imigran must not be used within 2 weeks of discontinuation of therapy with monoamine oxidase inhibitors
-ergotamine, or derivatives of ergotamine (including methysergide) or any triptan/5-hydroxytryptamine1 (5-HT1) receptor agonist is contraindicated
Imigran nasal spray directions
18 yrs or older:
Optimal dose=20mg in nose nostril. If patient doesn’t respond to first dose, another should NOT be taken for the same attack
No more than 2 doses of Imigran 20mg nasal spray in 24 hours
12-17 years of age:
10mg in one nostril. do NOT take 2nd dose for same attack.
If symptoms recur, can have 2nd dose but must be minimum of 2 hours between the two doses.
Maximum of 2 doses of 10mg in any 24 hour period
