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S3 Case 1 - Neurology > Migraine Pharmaceutical Care > Flashcards

Migraine Pharmaceutical Care Flashcards

1
Q

What are the different headache types?

A

Migraine with aura
Migraine without aura
Migraine aura without headache = silent migraine
Tension-type headache
Cluster headache
Medication overuse headache

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2
Q

What is aura?

A

Additional neurological changes

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3
Q

What medication can cause a headache?

A

Paracetamol

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4
Q

When would you need to refer someone with a headache?

A

Worsening with fever
New onset neurological deficit = stroke
New-onset cognitive dysfunction = confusion
Change in personality
Recent head trauma
Symptoms of giant cell arteritis
Symptoms of acute narrow angle glaucoma

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5
Q

What is giant cell arteritis?

A

Blood vessel inflammation

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6
Q

What are the symptoms of giant cell arteritis?

A

Burning pain in the face
= can go blind
= send to hospital

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7
Q

What is narrow angle glaucoma?

A

Space in the eye blocked

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8
Q

What are the symptoms of narrow angle glaucoma?

A

Stabbing pain
Blurred vision

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9
Q

What is the pain location for a tension-type headache?

A

Bilateral

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10
Q

What is the pain quality for a tension-type headache?

A

Pressing-tightening
(not pulsatile)

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11
Q

What is the pain intensity for a tension-type headache?

A

Mild-moderate

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12
Q

What is the effect on activities for a tension-type headache?

A

NOT aggravated by ADLS

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13
Q

What is the other symptoms for a tension-type headache?

A

NONE

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14
Q

What is the duration for a tension-type headache?

A

30mins to continuous

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15
Q

What is the pain location for a migraine (with/out aura)?

A

Unilateral/bilateral

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16
Q

What is the pain quality for a migraine (with/out aura)?

A

Pulsating
(throbbing/banging)

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17
Q

What is the pain intensity for a migraine (with/out aura)?

A

Moderate-severe

18
Q

What is the effect on activities for a migraine (with/out aura)?

A

Aggravated or worsened by ADLs

19
Q

What is the other symptoms for a migraine (with/out aura)?

A

Unusual sensitivity to light/sound
Nausea + vomiting
+/- aura

20
Q

What is the duration for a migraine (with/out aura)?

A

4-72hrs = adults
1-72hrs = 1-17 yo

21
Q

What is the pain location for a cluster headache?

A

Unilateral
(around eye, above eye, along side of face/head)

22
Q

What is the pain quality for a cluster headache?

A

Variable
(sharp/boring/burning/throbbing/tightening)

23
Q

What is the pain intensity for a cluster headache?

A

Severe to very severe

24
Q

What is the effect on activities for a cluster headache?

A

Restlessness or agitation

25
Q

What is the other symptoms for a cluster headache?

A

Red/watery eye
Nasal symptoms
Facial sweating
Constricted pupil, drooping eyelid

26
Q

What is the duration for a cluster headache?

A

15-180mins

27
Q

What are some migraine triggers?

A

Lack of sleep
Fatigue
Stress
Hormones
Vision, sound, smells
Foods
Vasodilators

28
Q

What are examples of vasodilators?

A

Cardiovascular drugs
- eg. CCB

29
Q

How can you diagnose?

A

Recommend using a headache diary for a minimum of 8 weeks

30
Q

What should be included in the headache diary?

A

Frequency, duration + severity
Associated symptoms
Medications
Possible triggers
Relationship of headaches to menstruation

31
Q

What do you need to do first when helping someone with a headache?

A

Medication review

32
Q

What do you do for an overuse medication headache?

A

Advise to abruptly STOP all acute medications - eg. triptans + simple analgesic
Restrict analgesics to no more than 2 days a week
Refer if opioid, barbiturate + tranquilisers

33
Q

What should you tell the patient when you stop their medication?

A

Initial worsening of headache - 1-2weeks
Will improve afterwards but can take 2-3months

34
Q

15 year old wants to buy some Anadin Original - assessment?
CASE STUDY - tension-type headache

A

Enquire about symptoms
Enquire about history
Headache features

35
Q

15 year old wants to buy some Anadin Original - treatment?
CASE STUDY - tension-type headache

A

NICE recommends aspirin, paracetamol or NSAID
BUT aspirin can’t be given to those under 16
= Reye’s syndrome
Do NOT offer opioids for tension-type

36
Q

What does NICE recommend for migraine with aura?

A

Triptan + NSAID
Triptan + paracetamol
Aspirin monotherapy, triptan or NSAID monotherapy

37
Q

What are the NSAID risks?

A

GI
Asthma
Rena
Cardiovascular

38
Q

What are the triptan risks?

A

Cardiovascular

39
Q

What is the treatment of being sick with a medicine?

A

Metoclopramide
Prochlorperazine - available as buccal so won’t be effected if sick

40
Q

What happens if they are on the contraceptive pill + are getting migraines with aura?

A

Should NOT take the pill due to increased risk of stroke
= STOP the pill

S3 Case 1 - Neurology (16 decks)

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