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PRE-REG-Thuri > NERVOUS SYSTEM - MIGRAINES + HEADACHES > Flashcards

NERVOUS SYSTEM - MIGRAINES + HEADACHES Flashcards

1
Q

what is a migraine?

A

Moderate to severe headache which is unilateral + pulsating

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2
Q

What 2 parts are migraines split into?

A

Episodic

Chronic

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3
Q

What is an Episodic migraine?

A

Migraine that occurs < 15 days of the month

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4
Q

What is a chronic migraine?

A

Migraine that occurs more than 15 days of the month + has characteristics of migraine headache for 8 days for more than 3 months.

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5
Q

What are 3 main symptoms of migraines?

A

Throbbing pain- 1 side

Nausea + vomiting

Sensitivity to light or sound

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6
Q

What else is migraine divided into?

A

With aura

Without aura

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7
Q

What are the 4 symptoms of Migraine with aura?

A
  1. Visual- flickering lights, blind spots, loss of vision, zig zags
  2. sensory - numbness or tingling on 1 hand/side of body
  3. Dizzy or off-balance
  4. Dysphasia (unable to speak/ understand language)
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8
Q

What 4 drug classes are used for migraine treatment?

A
  1. 5H1 receptor agonists
  2. oral analgesics
  3. anti-emetics
  4. Beta- blockers
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9
Q

What classifies an acute migraine attack?

A

Max 2 attacks per week

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10
Q

What is the 2 1st line treatments for acute migraine attacks?

A

Aspirin/ ibuprofen

OR

5HT1 receptor agonist e.g. triptan

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11
Q

List a couple 5H1 receptor agonists?

A

Sumtriptan

eletriptan

zolmitriptan

Rixatriptan

frovatriptan

almotriptan

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12
Q

List some oral analgesics used for migraine relief?

A

Paracetamol

Aspirin

Ibuprofen

Diclofenac

Tolfenamic acid

Mefenamic acid

Naproxen

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13
Q

What oral analgesic is used for menstrual migraine?

A

Mefenamic acid - if women using for other condition too like dysmenorrhoea

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14
Q

What oral NSAID can be used for acute migraine attack?

A

Tolfenamic acid

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15
Q

What 2 anti-emetics are used for migraines/ headaches?

A

Metoclopramide

Prochlorperazine - single doses for headaches

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16
Q

What 5ht antagonist/ antihistamine used for migraines result in weight gain?

A

Pizotifen

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17
Q

Which 3 triptans can be used for menstrual migraine?

A

frovatriptan

zolmitriptan

Naratriptan

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18
Q

What is the chosen triptan for acute migraine treatment?

A

sumatriptan

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19
Q

What type of aspirin is better for migraine treatment?

A

SOLUBLE

Dispersible as better absorbed

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20
Q

What 2 anti-emetics are given for nausea + vomiting with migraine?

A

Domperidone
OR
Metoclopramide

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21
Q

What is first line for migraine PROPHYLAXIS?

A

Propranolol

if contra- use metoprolol/nadolol

(maybe even amitriptyline)

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22
Q

What 5 drugs to use in same class if propranolol not suited for migraine PROPHYLAXIS? (5)

A

Metoprolol

Nadolol

Timolol

Atenolol

Bisoprolol

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23
Q

If all BB unsuitable for migraine prophylaxis, what anti-epileptic drug to use for migraine prophylaxis?

A

Topiramate

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24
Q

What is MOA of 5ht1 receptor agonists?

A

Acts on 5ht1 1B/1D receptors - causes vasoconstriction of cranium.

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25
What is indication of triptans?
Acute migraine attacks
26
How to take triptans?
1 dose ASAP after onset. 2nd dose 2 hours LATER
27
How to take naratriptan?
take 2nd dose 4 hours after 1st dose. Do not take 2nd dose for same attack if no response.
28
What is 1 SE of triptans?
coronary vasoconstriction
29
What signs mean you need to stop triptains?
Stop if heat, tightness in chest or throat
30
What are 4 contra-indications of triptan use?
not used for patients with MI, angina, stroke, moderate to severe or uncontrolled HTN
31
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
32
What is a cluster headache?
sharp, burning or piercing pain, usually on 1 side of the head, around the eye
33
What is 1st line treatment for cluster headache?
Sumatriptan given by SC injection
34
What route is Sumatriptan given for cluster headaches?
SC
35
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]
36
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.
37
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.
38
what 2 unlicensed drugs are used for prophylaxis of cluster headaches?
Verapamil hydrochloride OR lithium [both unlicensed use]
39
What unlicensed drug is used for short-term prophylaxis of episodic cluster headache?
Prednisolone - mono-therapy OR dual with verapamil during verapamil titration.
40
What type of patients is sumatriptan contra-indicated in?
uncontrolled hypertension, heart patients
41
What is trigeminal neuralgia?
Severe facial pain - electric shock like feeling in jaw , teeth gums Treat with carbemazepine
42
What is tension headache?
Bilateral throbbing pain like tight band on head paracetamol or ibuprofen
43
When to take the triptan for migraine?
As soon as patient gets migraine and before aura starts unless it starts at same time
44
When to give second dose of triptan?
Only if 1st dose positively somewhat worked
45
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.
46
What is max sumatriptan dose for migraines?
300mg per day
47
Why should metoclorpramide not be used regularly?
Risk of EPS
48
Which anti-hypertensive can be considered unlicensed for prophylaxis of migraines but NOT in pregnancy?
Candesartan
49
What can be given instead of, or in addition to, standard prophylactic treatment in women with perimenstrual migraine?
Frovatriptan
50
For treatment to be effective in women with perimenstrual migraine, what should happen?
Periods must be regular
51
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
52
What 2 sections are episodic migraine further divided into?
Low frequency High frequency
53
How many days is high frequency?
10-14 days per month
54
How many days is low frequency?
1-9 days per month
55
What is lifestyle advice for migraines?
Eat rreg meals, drink enough, sleep + exercise Avoid triggers Headache diary - min of 8 weeks
56
What Pain relief suppository is used to help with severe N+ V?
Diclofenac
57
What combo therapy is given for migraines if monotherapy fails?
Sumatriptan and naproxen
58
What ARB can be considered as prophylactic treatment for migraines?
Candesartan - NO in pregnancy
59
What drug is considered in patients over 55+ years for migraine?
Sodium valproate
60
How long should preventative treatment be tried for at least?
3 months at max tolerated dose.
61
What is a good response to treatment defined as?
50% reduction in severity/freq of migraine attacks
62
When should patients be referred to neurology with migraine?
If tried 3 or + drugs and not worked.
63
What is a cautionary label for triptains?
Can make you sleepy, if happens do not drive or use machines.

PRE-REG-Thuri (44 decks)

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