Migraines & Headaches

Question 1

Classes of drugs, which can cause headaches?

Answer 1

• hormone containing
• vitamins
• meds for erection issues
• caffeine
• meds for heart and BP

Question 2

Characteristics for Tension headache?

Answer 2

• Mild to mod pain
• Bilateral
• Non-pulsating
• Not aggravated by normal activity

Question 3

Characteristics of a Migraine?

Answer 3

• Moderate to severe pain
• Unilateral
• Pulsating
• Aggravated by normal activity such that the patient has to stop

Question 4

Types of headaches

Answer 4

• ice cream headaches
• chronic headaches
• cluster headaches
• sinister headaches
• migraines

Question 5

Ice-cream headaches?

Answer 5

• like a flash of lightning
• trigger: cold foods/drinks

Question 6

Chronic headaches?

Answer 6

• neck stiffness
• triggers: analgesic dependency

Question 7

Cluster headaches?

Answer 7

• red eye
• droopy eye
• eyelid oedema
• facial sweating
• nasal connection

Management:
• 100% oxygen
• sumatriptan s/c
• verapamil

Question 8

Sinister headache?

Answer 8

May indicate:
• haemorrhage
• meningitis
• depression

Question 9

Migraine symptoms?

Answer 9

• aura
• pulsating
• unilateral
• N&V
• photophobia

Question 10

Pathophysiology of migraine?

Answer 10

• genetic
• neurovascular - changes in cerebral flow
• neurotransmitter - changes in serotonin levels
• inflammatory - inflammation of meninges

Question 11

Trigger factors of a Migraine?

Answer 11

• diet - alcohol, chocolate, caffeine
• hormonal changes
• HRT, pill, pregnancy
• emotion

Question 12

What are the 4 phases of a migraine?

Answer 12

• prodrome phase (heighten feeling)
• aura phase (flashing lights)
• headache
• postdrome phase (resolution)

Question 13

Symptoms of Migraine (AUSTIN)

Answer 13

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

Question 14

Name of the Diagnosis system for Migraines?

Answer 14

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

Question 15

Differential diagnosis of Migraine
(red flag, urgent referral)

Answer 15

• meningitis (non blanching rash, neck stiffness)
• temporal arthritis
• haemorrhage
• fall/ trauma

Question 16

Acute first line treatment?

Answer 16

• 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

Question 17

Anti-emetic

Answer 17

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

Question 18

Triptans MOA

Answer 18

MOA:
• 5-HT agonist
• constricts blood vessels back to normal

C/I
• hypertension

SE:
• tightness on chest and throat
• dizziness

Question 19

Medication overuse headache?

Answer 19

? Taking medication too often for tension-type headache or migraine

Treatment: stop current therapy

People at risk: using analgesics/triptans for > 15days per month

Question 20

Preventing Medication overuse headache?

Answer 20

• < 15 days/month (analgesic & triptans)
• don’t not use > 2 days consequently
• avoid codeine

Question 21

Prophylaxis treatment for migraine?

Answer 21

Topiramate
• risk of fetal malformation
• impair hormonal contraceptives

Propranolol
• can be used by ppl with hypertension & anxiety
• c/I : asthmatic, COPD, PVD, heart failure

Question 22

Other prophylactic agents?

Answer 22

• antidepressants - TCA (amitriptyline)
• valproate
• BOTOX - relaxes the muscle
• acupuncture
• monoclonal antibodies (last resort)

Question 23

Pharmacist Role?

Answer 23

• Raise awareness of migraine
• Signpost patients for
• Identify OTC analgesic overuse
• Help doctors with management
• Educate patients on realistic expectations

Question 24

Patient expectations?

Answer 24

• will not provide a migraine-free life
• breakthrough headaches
• side effects
• weight gain
• will take time to become effective