MIGRAINES + HEADACHES Flashcards
Which drugs are used for headaches?
- Clonidine
- Verapamil
- Sumatriptan, Zolmitriptan
- Analgesics
Clonidine
- A centrally acting antihypertensive
- Used for the prevention of recurrent migraines and prevention of vascular headaches
Verapamil
- Rate-limiting CCB
- Prophylaxis of cluster
Sumartriptan, Zolmitriptan
- Cluster headaches
Analgesics
e.g. Paracetamol, Ibuprofen
What are the symptoms of migraines?
- Unilateral (affecting one side of the head)
- Alterations in vision
- Tingling/numbness on one side of the body lin lips, fingers, face, or hands) before an attack starts
- N+V
- Photophobia
In which gender are migraines more common?
Women
How long do Migraines last for?
- Reccurent: 4-72 hours
- Episodic: less than 15 days per month
- Chronic: Headache for more than 15 days and migraine symptoms for at least 8 days a month for longer than 3 months
What are the two types of migraines?
- Migraine
- Migraine with aura
Migraine with aura
- Typical unilateral headache
- visual symptoms e.g. zigzag or flickering lights, spots, lines, or loss of vision
- sensory symptoms e.g. pins and needles, or numbness
- dysphasia
What are some trigger factors for migraine?
- Stress
- Relaxation after stress
- Certain foods and drinks
- Bright lights
- Menstruation (due to a drop in oestrogen levels)
How do you treat a migraine?
- Simple analgesics
- Aspirin, Paracetamol (preferable in soluble or dispersible form)
- NSAID (Tolfenamic acid licensed specifically for migraines)
When should patients administer treatment for migraines?
- Migraine onset ASAP
- In migraine with aura, triptans should be taken in beginning of migraine e.g. headache, NOT when aura starts unless aura and headache happen at start together.
Why is dispersible/ solution preferred
- Peritalsis is reduced in attacks of migraines
- absorption is affected
Ergot Alkaloids and migraine
Ergotamine tartrate
- Its use is limited by
difficulties in absorption and by its side-effects.
- Treatment should not be repeated at intervals of less than 4 days
- Treatment should not be repeated more than TWICE a month
- Can be given for cluster headaches at a low dose for 1-2 weeks
Ergotamine tartrate - SE
N&V,
abdominal pain, and muscular cramps
What is the risk of excessive use of acute treatments for migraines?
associated with medication-overuse headaches
What can you give for
N&V associated with Migraines?
Antiemetics
- e.g. metoclopramide, domperidone, phenothiazine, and antihistamines
- Metoclopramide or domperidone may be better since they promote gastric emptying and normal peristalsis
- ONSET
Oral contraceptives and migraine
- COMBINED oral contraceptives can provoke migraine
When would patients be indicated for prophylaxis of migraines?
- Suffer at least 2 attacks a month
- Suffer an increasing frequency of headaches
- Suffer significant disability despite suitable treatment for migraine attacks
- Cannot take suitable treatment for migraine attacks
What treatments are used for migraine prophylaxis?
- Beta-Blockers
- TCAs
- Gabapentin
- Topiramate
- Sodium valproate and valproic acid
- Pizotifen
- Limited use
- Cause weight gain as side-effect
Beta-Blockers
- Propranolol (MOST COMMON)
- Atenolol (unlicensed)
- Metoprolol
- Nadalol
- Timolol
- Bisoprolol (ulicensed - but useful if patient already taking for an existing cardiac disorder)
Pizotifen
- Limited use
- Cause weight gain as side-effect
When would you give botulinum toxin A in migraines?
- Only initiated by specialists
- When 3 or more
prophylactics treatments have failed
