Migraine

Question 1

Which analgesics are effective for the treatment of most analgesics and why are dispensable formulations of these drugs preferred?

Answer 1

1) Analgesics such as aspirin or paracetamol
2) dispersible formulations preferred as peristalsis is often reduced during migraine attacks so medication may not be sufficiently well absorbed to be effective

Question 2

which NSAID is licensed specifically for the treatment of an acute attack of migraine?

Answer 2

1) Tolfenamic acid

2) Diclofenac POTASSIUM, flurbiprofen, and ibuprofen are also licensed for use in migraine

Question 3

what is the treatment of choice for migraines, in those who fail to respond to conventional analgesics ?

Answer 3

1) 5HT1B/1D-receptor agonist (‘triptans’)- used during the established headache phase of an attack
↳(not indicated for : hemiplegic, basilar, or opthalmoplegic migraine)

Question 4

1) list 3 5HT1-receptor agonists which can be used to treat migraines
2) If a Patient dosent respond to one 5HT1-receptor agonist what should be tried?

Answer 4

1) Naratriptan, rizatriptan, sumatriptan, and zolmitriptan
2) An alternative 5HT1 agonist should be tried- in patients who have prolonged attacks despite treatment with a 5HT1, consider adding NSAID such as naproxen

Question 5

Which 5HT1-receptor agonists can also be used to treat cluster headaches? (2)

Answer 5

Sumatriptan or zolmitriptan

Question 6

Ergotamine is best avoided for the treatment of migraine due to difficulties in absorption. What side effects does it cause? (4)

Answer 6

1) Nausea
2) Vomiting
3) Abdominal pain
4) Muscular cramps

Question 7

1) Doses of ergotamine preparations should not be exceeded and treatment should not be repeated within what period of time?
2) To avoid habituation the frequency of administration should be limited to no more than how many times a month?

Answer 7

1) Not be repeated at intervals of less than 4 days

2) limited to no more than twice a month

Question 8

which antiemetics can be given to relieve nausea associated with migraine attacks?

Answer 8

Metoclopramide, domperidone, or phenothiazine

Question 9

Why might metoclopramide and domperidone be particularly useful for treating nausea associated with migraines?

Answer 9

Added advantage of promoting gastric emptying and normal peristalsis; a single dose should be given at the onset of symptoms

Question 10

Where migraine attacks are frequent, possible provoking factors should be assessed. List some factors that can provoke migraine attacks?

Answer 10

1) Stress
2) Irregular life-style (e.g. lack of sleep)
3) Chemical triggers (e.g. alcohol and nitrates)
4) Combined oral contraceptives

Question 11

Preventive treatment for migraine should be considered for patients who meet which 4 criteria?

Answer 11

1) Suffer at least two attacks a month;
2) Suffer an increasing frequency of headaches;
3) Suffer significant disability despite suitable treatment for migraine attacks;
4) Cannot take suitable treatment for migraine attacks

Question 12

which beta blocker is most commonly used for the prophylaxis of migraines?

Answer 12

1) Propranolol

Atenolol, metoprolol, nadolol, and timolol are also effective

Question 13

Apart from beta blockers, which other drugs are also effective for treating migraines? (4)

Answer 13

TCAs, gabapentin, topiramate, valproate - (careful with women of childbearing age)

Question 14

Pizotifen is an antihistamine and a serotonin-receptor antagonist. why might it of limited value in the treatment of migraines?

Answer 14

may cause weight gain

Question 15

what drug is licensed for the prophylaxis of headaches in adults with chronic migraine

Answer 15

Botulinum toxin type A

Question 16

1) what is the drug of choice for the treatment of cluster headaches?
2) what other treatments can be used for this condition?

Answer 16

1) Sumatriptan given by subcutaneous injection
2) If unsuitable, sumatriptan nasal spray or zolmitriptan nasal spraymay be used.
3) Alternatively, 100% oxygen is useful in aborting an attack

Question 17

Prophylaxis of cluster headache is considered if the attacks are frequent, last over 3 weeks, or if they cannot be treated effectively. Which drugs are used for the prophylaxis of cluster headaches?

Answer 17

1) Verapamil or lithium

2) Prednisolone can be used for short-term prophylaxis

Question 18

Ergot alkaloids are rarely required now; oral preparations are associated with many side-effects and should be avoided in which type of disease?

Answer 18

cerebrovascular or cardiovascular disease