Migraines

Question 1

what are the 2 types of migraines?

Answer 1

-unilateral and pulsating
-accompanied with nausea and vomiting, photophobia and phonophobia
-affects daily activities

Question 2

what is does an aura cause?

Answer 2

can cause visual (zigzag or flickering lights, spots, lines) and sensory symptoms (pins and needles or numbness)
-dysphasia

Question 3

what is the treatment for migraines? avoid?

Answer 3

-hydration, sleep, exercise
-avoid chocolate and wine
-relax after stress
-headaches diary may be useful to identify potential triggers

Question 4

what is the acute treatment for migraines?

Answer 4

-treat with aspirin or triptan favourable one is sumatriptan
-take as soon as the patient knows they are developing a migraine
-with aura: triptan taken at the start of the headache and not at the start of the aura
-triptan can be repeated after 2hrs (4hrs in naratriptan)

Question 5

when are you able to take another triptan with miraines?

Answer 5

after 2 hours if you had a response from the first one but its effect wasn’t adequate only.

Question 6

if patient isn’t able to use the first line agents what should be used?

Answer 6

soluble paracetamol- because faster onset of action than normal prepartion

Question 7

what anti-emetics may be prescribed if needed for migraines?

Answer 7

metoclopramide or prochloperazine

Question 8

what can be used as prophylaxis for migraines

Answer 8

first line: propranolol, if contraindicated use metoprolol or nadalol
or amitriptyline is effective (less sedating TCA if amitriptyline is not tolerated
-sodium valporate, pizotifen or botox used normally under specialist use

Question 9

what group of patients should not use triptans?

Answer 9

-uncontrolled hypertension/cardiac events works by constricting blood vessels

Question 10

what are cluster headaches?treatment? prophylaxis?

Answer 10

-intense unilateral pain or around one eye
-acute SC sumatriptan (nasal sumatriptan/zolmitriptan given if unavailable)
-prophylaxis: verapamil, lithium, prednisolone or ergotamine tartate (rarely used)

Question 11

what is a trigeminal neuralgia?treatment?

Answer 11

-severe head pain and jaw,teeth or gums , more like electric shock
treatment is carbamazepine

Question 12

what are tension headaches?

Answer 12

-bilateral throbbing pain like a tight band around your head
-paracetamol or ibuprofen

Question 13

if some has a severe headaches at back of head like where neck is, sudden pain what is the cause of action?

Answer 13

-refer to A&E due to describing a subarachnoid hemorrhage -bleed