NERVOUS SYSTEM - MIGRAINES + HEADACHES Flashcards
what is a migraine?
Moderate to severe headache which is unilateral + pulsating
What 2 parts are migraines split into?
Episodic
Chronic
What is an Episodic migraine?
Migraine that occurs < 15 days of the month
What is a chronic migraine?
Migraine that occurs more than 15 days of the month + has characteristics of migraine headache for 8 days for more than 3 months.
What are 3 main symptoms of migraines?
Throbbing pain- 1 side
Nausea + vomiting
Sensitivity to light or sound
What else is migraine divided into?
With aura
Without aura
What are the 4 symptoms of Migraine with aura?
- Visual- flickering lights, blind spots, loss of vision, zig zags
- sensory - numbness or tingling on 1 hand/side of body
- Dizzy or off-balance
- Dysphasia (unable to speak/ understand language)
What 4 drug classes are used for migraine treatment?
- 5H1 receptor agonists
- oral analgesics
- anti-emetics
- Beta- blockers
What classifies an acute migraine attack?
Max 2 attacks per week
What is the 2 1st line treatments for acute migraine attacks?
Aspirin/ ibuprofen
OR
5HT1 receptor agonist e.g. triptan
List a couple 5H1 receptor agonists?
Sumtriptan
eletriptan
zolmitriptan
Rixatriptan
frovatriptan
almotriptan
List some oral analgesics used for migraine relief?
Paracetamol
Aspirin
Ibuprofen
Diclofenac
Tolfenamic acid
Mefenamic acid
Naproxen
What oral analgesic is used for menstrual migraine?
Mefenamic acid - if women using for other condition too like dysmenorrhoea
What oral NSAID can be used for acute migraine attack?
Tolfenamic acid
What 2 anti-emetics are used for migraines/ headaches?
Metoclopramide
Prochlorperazine - single doses for headaches
What 5ht antagonist/ antihistamine used for migraines result in weight gain?
Pizotifen
Which 3 triptans can be used for menstrual migraine?
frovatriptan
zolmitriptan
Naratriptan
What is the chosen triptan for acute migraine treatment?
sumatriptan
What type of aspirin is better for migraine treatment?
SOLUBLE
Dispersible as better absorbed
What 2 anti-emetics are given for nausea + vomiting with migraine?
Domperidone
OR
Metoclopramide
What is first line for migraine PROPHYLAXIS?
Propranolol
if contra- use metoprolol/nadolol
(maybe even amitriptyline)
What 5 drugs to use in same class if propranolol not suited for migraine PROPHYLAXIS? (5)
Metoprolol
Nadolol
Timolol
Atenolol
Bisoprolol
If all BB unsuitable for migraine prophylaxis, what anti-epileptic drug to use for migraine prophylaxis?
Topiramate
What is MOA of 5ht1 receptor agonists?
Acts on 5ht1 1B/1D receptors - causes vasoconstriction of cranium.
What is indication of triptans?
Acute migraine attacks
How to take triptans?
1 dose ASAP after onset.
2nd dose 2 hours LATER
How to take naratriptan?
take 2nd dose 4 hours after 1st dose.
Do not take 2nd dose for same attack if no response.
What is 1 SE of triptans?
coronary vasoconstriction
What signs mean you need to stop triptains?
Stop if heat, tightness in chest or throat
What are 4 contra-indications of triptan use?
not used for patients with MI, angina, stroke, moderate to severe or uncontrolled HTN
What drug classes can interact with triptans to increase risk of serotonin syndrome?
antidepressants, Lithium , MAO-B inhibitors, methadone, st john’s wort, triptans, tramadol, anfetamines
What is a cluster headache?
sharp, burning or piercing pain, usually on 1 side of the head, around the eye
What is 1st line treatment for cluster headache?
Sumatriptan given by SC injection
What route is Sumatriptan given for cluster headaches?
SC
What 2 triptans can be used in patients with early vomiting or have severe migraine attacks?
sumatriptan nasal spray OR zolmitriptan nasal spray [both unlicensed use]
What is a way of preventing attack of cluster headache?
100% oxygen at a rate of 10–15 litres/minute for 10–20 minutes is useful in aborting an attack.
What 3 conditions is prophylaxis of cluster headache considered?
if the attacks are frequent,
Or
If they last OVER 3 weeks
Or
if they cannot be treated effectively.
what 2 unlicensed drugs are used for prophylaxis of cluster headaches?
Verapamil hydrochloride OR lithium [both unlicensed use]
What unlicensed drug is used for short-term prophylaxis of episodic cluster headache?
Prednisolone - mono-therapy OR dual with verapamil during verapamil titration.
What type of patients is sumatriptan contra-indicated in?
uncontrolled hypertension, heart patients
What is trigeminal neuralgia?
Severe facial pain - electric shock like feeling in jaw , teeth gums
Treat with carbemazepine
What is tension headache?
Bilateral throbbing pain like tight band on head
paracetamol or ibuprofen
When to take the triptan for migraine?
As soon as patient gets migraine and before aura starts unless it starts at same time
When to give second dose of triptan?
Only if 1st dose positively somewhat worked
What other drug can be considered other than propranolol for migraine prophylaxis, especially if they have episodic or chronic migraine?
Amitriptyline
Can use less sedating one too.
What is max sumatriptan dose for migraines?
300mg per day
Why should metoclorpramide not be used regularly?
Risk of EPS
Which anti-hypertensive can be considered unlicensed for prophylaxis of migraines but NOT in pregnancy?
Candesartan
What can be given instead of, or in addition to, standard prophylactic treatment in women with perimenstrual migraine?
Frovatriptan
For treatment to be effective in women with perimenstrual migraine, what should happen?
Periods must be regular
What is recommended for prophylaxis of chronic migraine where medication-overuse has been addressed + where 3 + oral prophylactic treatments have failed?
Botox A- specialist use
What 2 sections are episodic migraine further divided into?
Low frequency
High frequency
How many days is high frequency?
10-14 days per month
How many days is low frequency?
1-9 days per month
What is lifestyle advice for migraines?
Eat rreg meals, drink enough, sleep + exercise
Avoid triggers
Headache diary - min of 8 weeks
What Pain relief suppository is used to help with severe N+ V?
Diclofenac
What combo therapy is given for migraines if monotherapy fails?
Sumatriptan and naproxen
What ARB can be considered as prophylactic treatment for migraines?
Candesartan - NO in pregnancy
What drug is considered in patients over 55+ years for migraine?
Sodium valproate
How long should preventative treatment be tried for at least?
3 months at max tolerated dose.
What is a good response to treatment defined as?
50% reduction in severity/freq of migraine attacks
When should patients be referred to neurology with migraine?
If tried 3 or + drugs and not worked.
What is a cautionary label for triptains?
Can make you sleepy, if happens do not drive or use machines.
