Migraine

Question 1

A migraine can be divided into how many phases?

Answer 1

Three:
Phase one, premonitory phase -which can occur hours or possibly a couple of days before the headache.
Phase two, headache with or without aura.
Phase three, Resolution phase.

Question 2

What is ‘classic migraine’?

Answer 2

Headache with aura, accounts for <25% cases.

Aura which is fully reversible develops over 5 to 20min and can last up to 1hr.

Aura is either visual (90%) or neurological.

Question 3

75% of migraine is what?

Answer 3

Common headache with aura.

Question 4

How does sinusitis present?

Answer 4

Pain tends to be relatively localised, ususally orbital, unilateral and dull.

A course of decongestants can be tried, but if treatment failure occurs, referral to the foctor for possible antibiotic therapy would be appropriate.

Question 5

Cluster headache predominatly affects who?

Answer 5

Men over the age of 30, typically headache will occur at the same time each day with abrupt onset and lasts between 10mins to 3 hours with 50% of patients experiencing night time symptoms.

Question 6

Why do medication-overuse headaches occur?

Answer 6

Pain receptors (nociceptors) instead of being switched off when analgesics are used are in fact switched on.

Question 7

What is temporal arteritits?

Answer 7

The temporal arteries run vertically up the side of the head, just in front of the ears and can become inflamed,

When this happens they are tender to touch and can be visibly thickened.

Unilateral pain is experienced and the person generally feels unwell with fever, myalgia and general malaise.

Question 8

Temporal arteritis is most commonly seen in what patients?

Answer 8

The elderly, especially women.

Question 9

How is temporal arteritis treated?

Answer 9

Prompt treatment with oral corticosteroids is required, as the retinal artery can become compromised, leading to blindness.

Question 10

What does trigeminal neuralgia present as?

Answer 10

The pain follows the course of either the second (maxillary; supplying the cheeks) or third (mandibular; supplying the chin, lower lip and lower cheek) division of the nerve, leading to pain experienced in the cheek, jaw, lips and gums. Pain is short lived, usually lasting only a couple of minutes but is severe and lancing and is almost always unilateral. It is 3x more common in women than men.

Question 11

Headache that has lasted for more than how long should be referred?

Answer 11

2 weeks, most acute (uncomplicated) cases will last less than 2 weeks.

Question 12

Why would a headache in children under 12, with a stiff neck, high temperature or skin rash need to be referred?

Answer 12

Meningitis.

Question 13

How does prochlorperazine work? (Buccastem M)

Answer 13

Blocking dopamine receptors found in the chemoreceptor trigger zone.

Administered via the buccal mucosa and there patients should NOT be counselled swallow it.

Question 14

What is the rationale for the use of triptans in migraine?

Answer 14

Triptans are 5-HT1 agonists and stimulate 5-HT1b and 5-HT1D receptors, causing constriction of the cranial blood vessels, stop the release of inflammatory neurotransmitters at the trigeminal nerve synapses and reduce pain signal transduction.

Question 15

What form of analgesia is best recommended for migraine pain relief, why?

Answer 15

Soluble or orodispersible formulations to maximise absorption before it is inhibited by gastric stasis.

Question 16

Age limit on buccastem

Answer 16

18 and over

Question 17

Migraleve actives

Answer 17

Buclizine (antimuscarinc)
Codeine
paracetamol

Question 18

Migraleve pink contains

Answer 18

All three, buclizine, paracetamol and codeine

Question 19

Migraleve yellow contains

Answer 19

Para and codeine

Question 20

What colour migraleve is meant to be taken first?

Answer 20

Pink

Question 21

Age range for OTC sumatriptan products? (Migraleve Ultra, Imigran Recovery, Migraitan)

Answer 21

18-65

Question 22

How should sumatriptan be used OTC?

Answer 22

A single 50mg tablets as soon as possible after the onset of the headache, if the headache clears and then recurs a second tablet can be taken, provided there was a response to the first tablet and more than 2 hours has elapsed since the first tablet.

Question 23

No more than how much mg sumatriptan can be used per 24hrs?

Answer 23

100mg two tabs of 50mg

Question 24

How long does it take for Buccastem M to completely dissolve?

Answer 24

3-5 hours, tab will soften and form a gel-like substance after 1-2 hours and then take 3-5 hours to dissolve completely.

If food or drinks are to be consumed during this time, place the tablet between the upper lip and gum, above the front teeth.

Question 25

Triptans should be avoided in what patient groups? (7)

Answer 25

Over 65
Previous MI, IHD, TIA, peripheral vascular disease.
Cardiac arrhythmias.
Hypertension.
History of seizures. 
Hepatic and renal impairment. 
Atypical migraines.

Question 26

Buccastem should be avoided in what patient groups? (4)

Answer 26

1. Under 18s
2. PArkinsons disease
3. Epilepsy
4. Glaucoma

Question 27

Migraleve should be avoided in what patients? (2)

Answer 27

1. Glaucoma patients

2. Prostate enlargement

Question 28

With regard to pregnancy and breastfeeding, what is the safety profile of triptans

Answer 28

SPC states used safely in first trimester of pregnancy and breastfeeding can be continued providing 12 hours have elapsed since taking a dose.