Migraines & Headaches Flashcards
Classes of drugs, which can cause headaches?
- hormone containing
- vitamins
- meds for erection issues
- caffeine
- meds for heart and BP
Characteristics for Tension headache?
• Mild to mod pain
• Bilateral
• Non-pulsating
• Not aggravated by normal activity
Characteristics of a Migraine?
• Moderate to severe pain
• Unilateral
• Pulsating
• Aggravated by normal activity such that the patient has to stop
Types of headaches
• ice cream headaches
• chronic headaches
• cluster headaches
• sinister headaches
• migraines
Ice-cream headaches?
• like a flash of lightning
• trigger: cold foods/drinks
Chronic headaches?
• neck stiffness
• triggers: analgesic dependency
Cluster headaches?
• red eye
• droopy eye
• eyelid oedema
• facial sweating
• nasal connection
Management:
• 100% oxygen
• sumatriptan s/c
• verapamil
Sinister headache?
May indicate:
• haemorrhage
• meningitis
• depression
Migraine symptoms?
- aura
- pulsating
- unilateral
- N&V
- photophobia
Pathophysiology of migraine?
• genetic
• neurovascular - changes in cerebral flow
• neurotransmitter - changes in serotonin levels
• inflammatory - inflammation of meninges
Trigger factors of a Migraine?
• diet - alcohol, chocolate, caffeine
• hormonal changes
• HRT, pill, pregnancy
• emotion
What are the 4 phases of a migraine?
• prodrome phase (heighten feeling)
• aura phase (flashing lights)
• headache
• postdrome phase (resolution)
Symptoms of Migraine (AUSTIN)
A - aggravated by activity
U - unilateral location
S- sensitivity to light and sound
T- throbbing in nature
I - intensity, moderate - severe
N -nausea/vomiting present
Name of the Diagnosis system for Migraines?
International headache society (IHS)
Repeated attacks of headache - lasting 24-73 hours:
Must have at-least 2 of:
• unilateral pain
• mod-severe
• throbbing
• aggravated by activity
Must have at-least 1 of:
• N/V
• photophobia
Differential diagnosis of Migraine
(red flag, urgent referral)
• meningitis (non blanching rash, neck stiffness)
• temporal arthritis
• haemorrhage
• fall/ trauma
Acute first line treatment?
• offer analgesic
• offer triptan (sumatriptan) - if n/v give s/c or nasal
• NSAID: diclofenac, aspirin, ibuprofen
If monotherapy is preferred:
• NSAID OR
• triptan OR
• paracetamol
• aspirin
Anti-emetic
Consider adding an anti-Emetic, even in the absence of n/v
• domperidone (not longer than 1/week)
• prochloperazine
• metochlopramide
If vomiting restricts oral treatment
• domperidone - suppositories
Triptans MOA
MOA:
• 5-HT agonist
• constricts blood vessels back to normal
C/I
• hypertension
SE:
• tightness on chest and throat
• dizziness
Medication overuse headache?
? Taking medication too often for tension-type headache or migraine
Treatment: stop current therapy
People at risk: using analgesics/triptans for > 15days per month
Preventing Medication overuse headache?
• < 15 days/month (analgesic & triptans)
• don’t not use > 2 days consequently
• avoid codeine
Prophylaxis treatment for migraine?
Topiramate
• risk of fetal malformation
• impair hormonal contraceptives
Propranolol
• can be used by ppl with hypertension & anxiety
• c/I : asthmatic, COPD, PVD, heart failure
Other prophylactic agents?
• antidepressants - TCA (amitriptyline)
• valproate
• BOTOX - relaxes the muscle
• acupuncture
• monoclonal antibodies (last resort)
Pharmacist Role?
• Raise awareness of migraine
• Signpost patients for
• Identify OTC analgesic overuse
• Help doctors with management
• Educate patients on realistic expectations
Patient expectations?
• will not provide a migraine-free life
• breakthrough headaches
• side effects
• weight gain
• will take time to become effective
