Migraine Pharmaceutical Care

Question 1

What are the different headache types?

Answer 1

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

Question 2

What is aura?

Answer 2

Additional neurological changes

Question 3

What medication can cause a headache?

Answer 3

Paracetamol

Question 4

When would you need to refer someone with a headache?

Answer 4

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

Question 5

What is giant cell arteritis?

Answer 5

Blood vessel inflammation

Question 6

What are the symptoms of giant cell arteritis?

Answer 6

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

Question 7

What is narrow angle glaucoma?

Answer 7

Space in the eye blocked

Question 8

What are the symptoms of narrow angle glaucoma?

Answer 8

Stabbing pain
Blurred vision

Question 9

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

Answer 9

Bilateral

Question 10

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

Answer 10

Pressing-tightening
(not pulsatile)

Question 11

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

Answer 11

Mild-moderate

Question 12

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

Answer 12

NOT aggravated by ADLS

Question 13

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

Answer 13

NONE

Question 14

What is the duration for a tension-type headache?

Answer 14

30mins to continuous

Question 15

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

Answer 15

Unilateral/bilateral

Question 16

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

Answer 16

Pulsating
(throbbing/banging)

Question 17

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

Answer 17

Moderate-severe

Question 18

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

Answer 18

Aggravated or worsened by ADLs

Question 19

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

Answer 19

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

Question 20

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

Answer 20

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

Question 21

What is the pain location for a cluster headache?

Answer 21

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

Question 22

What is the pain quality for a cluster headache?

Answer 22

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

Question 23

What is the pain intensity for a cluster headache?

Answer 23

Severe to very severe

Question 24

What is the effect on activities for a cluster headache?

Answer 24

Restlessness or agitation

Question 25

What is the other symptoms for a cluster headache?

Answer 25

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

Question 26

What is the duration for a cluster headache?

Answer 26

15-180mins

Question 27

What are some migraine triggers?

Answer 27

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

Question 28

What are examples of vasodilators?

Answer 28

Cardiovascular drugs - eg. CCB

Question 29

How can you diagnose?

Answer 29

Recommend using a headache diary for a minimum of 8 weeks

Question 30

What should be included in the headache diary?

Answer 30

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

Question 31

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

Answer 31

Medication review

Question 32

What do you do for an overuse medication headache?

Answer 32

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

Question 33

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

Answer 33

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

Question 34

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

Answer 34

Enquire about symptoms Enquire about history Headache features

Question 35

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

Answer 35

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

Question 36

What does NICE recommend for migraine with aura?

Answer 36

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

Question 37

What are the NSAID risks?

Answer 37

GI Asthma Rena Cardiovascular

Question 38

What are the triptan risks?

Answer 38

Cardiovascular

Question 39

What is the treatment of being sick with a medicine?

Answer 39

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

Question 40

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

Answer 40

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