PH1122 - Headaches Flashcards
Describe the symptoms associated with a tension headache.
Pain is bifrontal or bioccipital, generalized and nonthrobbing
The pain is gradual in onset and tends to worsen progressively throughout the day.
Nausea and vomiting are not associated with tension-type headache, and it rarely causes photophobia or phonophobia.
when should a patient with a tension headache be referred?
Patients who have frequent episodic tension-type headaches suffer more frequent headaches (more than monthly episodes) and, over time, these can develop into chronic tension-type headache. Headaches occur on at least 10 episodes per month and might be daily, lasting for at least 3 months. These types of headaches can severely affect the patient’s quality of life and should not be managed by the community pharmacist.
When should someone experiencing a migraine be referred ?
Anyone over 50 experiencing a migraine for the first time.
What are the three phases of a migraine attack ?
Phase one: Premonitory phase, which can occur hours or possibly a couple of days before the headache. The patient might complain of a change in mood or notice a change in behaviour. Feelings of well-being, yawning, poor concentration and food cravings have been reported.
Phase two: Headache with or without aura.
Phase three: Resolution phase, as the headache subsides; The patient can feel lethargic, tired and drained before recovery, which might take several hours.
What are symptoms for migraine with an aura (classic Migraine)?
The aura, which is fully reversible, develops over 5 to 20 minutes and can last for up to 1 hour.
Visual auras can take many forms, such as scotomas (blind spots), fortification spectra (zigzag lines) or flashing and flickering lights.
Neurological auras (pins and needles) typically start in the hand, migrating up the arm before jumping to the face and lips.
Within 60 minutes of the aura ending, the headache usually occurs. Pain is unilateral, throbbing and moderate to severe. Sometimes the pain becomes more generalised and diffuse. Physical activity and movement tend to intensify the pain. Nausea affects almost all patients but less than one-third will vomit. Photophobia and phonophobia often mean that patients will seek out a dark quiet room to relieve their symptoms. The patient might also suffer from fatigue, find concentrating difficult, and be irritable.
What are symptoms of a migraine without aura (common migraine) ?
sufferers do not experience an aura but do suffer from all other symptoms
Pain is unilateral, throbbing and moderate to severe. Sometimes the pain becomes more generalised and diffuse. Physical activity and movement tend to intensify the pain. Nausea affects almost all patients but less than one-third will vomit. Photophobia and phonophobia often mean that patients will seek out a dark quiet room to relieve their symptoms. The patient might also suffer from fatigue, find concentrating difficult, and be irritable.
What are some likely causes of headaches ?
Eye strain
People who perform prolonged close work – for example, visual display unit (VDU) operators – can suffer from frontal-aching headache. In the first case, patients should be REFERRED TO AN OPTICIAN for a routine eye check.
Sinusitis
The pain tends to be relatively localised, usually orbital, unilateral, and dull. For further information on the signs and symptoms of sinusitis, see under the cold section in chapter 2 . A course of decongestants could be tried, but if treatment failure occurs, referral to the doctor for possible antibiotic therapy would be appropriate.
What are symptoms of a cluster headache ?
Typically, the headache occurs at the same time each day with abrupt onset and lasts between 10 minutes and 3 hours, with 50% of patients experiencing nighttime symptoms. Patients are awoken 2 to 3 hours after falling asleep, with very intense, unilateral, orbital-boring pain. Additionally, conjunctival redness, lacrimation and nasal congestion (which laterally becomes watery) are observed on the pain side of the head. Facial flushing and sweating are common. Patients tend to be restless and irritable and often pace the floor.
The condition is characterized by periods of acute attacks, typically lasting a number of weeks to a few months, with sufferers experiencing between one and three attacks per day. This is then followed by periods of remission, which can last months or years. During acute phases, alcohol can trigger an attack. Nausea is usually absent, and a family history is uncommon. Referral is required because subcutaneous sumatriptan is required.
What are the symptoms for Temporal arteritis and what would the treatment be ?
Temporal arteritis (giant cell arteritis) The temporal arteries that run vertically up the sides of the head, just in front of the ears, can become inflamed. Unilateral pain is experienced, and the person generally feels unwell, with fever, myalgia and general malaise. Scalp tenderness is seen about 50% of patients. It is most commonly seen in older white populations and is three times more common in women. Prompt treatment with oral corticosteroids is required because the retinal artery can become compromised, leading to blindness. Urgent referral is needed.
What type of headache is associated with depression and what are further signs of depression ?
Depression
A symptom of depression can be tension-type headaches. However, other more prominent symptoms should be present. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria are often used to aid a diagnosis of depression. The pharmacist should check for a loss of interest or pleasure in activities, fatigue, inability to concentrate, loss of appetite, weight loss, sleep disturbances and constipation. If the patient exhibits some of these features (especially loss of interest in doing things and feeling down and hopeless), referral to the doctor is necessary.
As meningitis has a headache as one of the symptoms what are all of the symptoms of meningitis ?
Signs and symptoms are nonspecific in the early stages of the disease and are SIMILAR TO FLU, but can develop quickly to SEVERE GENERALIZED HEADACHE associated with FEVER (although neonates may not have fever), an obviously ill patient, NECK STIFFNESS, NAUSEA AND VOMITING. Latterly a NONBLANCHING PURPURIC RASH are classically associated with meningitis. However, not all patients will exhibit all symptoms, and any child that has difficulty in placing the chin on the chest and is running a temperature above 38.9°C (102°F) should be referred urgently.
What are some general reasons to refer someone with a headache ?
Headache in children <12 years old who have a stiff neck, high temperature or skin rash- MENINGITIS? Immediate referral to general practitioner (GP) or A&E
Headache after recent (1–3 months) trauma or injury- HAEMATOMA?
Nausea and/or vomiting in the absence of migraine symptoms
Neurological symptoms, if migraine is excluded, especially change in consciousness
Very sudden and/or severe onset of headache
All can suggest sinister pathology and require further investigation.
New or severe headache in patients > 50 years
Progressive worsening of headache symptoms over time Refer as soon as practicable to GP
Headache unresponsive to analgesics-Simple analgesia is effective; if this has not worked, the patient’s symptoms require further investigation. Suspect medication overuse headache.
children younger than 12 years are probably best referred if they show no signs of a systemic infection (e.g., fever, malaise).
What OTC medication is effective for treating a migraine ?
Simple analgesia (e.g., paracetamol, aspirin, ibuprofen) has shown clinical benefit in relieving migraine attacks
There is low quality evidence that fever few is effective migraine prevention
Migraleve has significance showing that is does reduce the severity of attacks but not the duration.
Prochlorperazine (Buccastem M)
Prochlorperazine has been found to be a potent antiemetic in a number of conditions, including migraine. It works by blocking dopamine receptors found in the chemoreceptor trigger zone. It is administered via the buccal mucosa, and therefore patients will need to be counselled on correct administration.
Sumatriptan Sumatriptan was the first triptan to be marketed in the UK and, subsequently, deregulated to OTC status. Triptans are 5-HT1 agonists and stimulate 5-HT1B and 5-HT1D receptors. Triptans cause constriction of the cranial blood vessels, stop the release of inflammatory neurotransmitters at the trigeminal nerve synapses, and reduce pain signal transmission. As a class of medicines, they have been extensively researched. Most trials with sumatriptan (and other triptans) use endpoint data of a 2-hour pain-free response, headache relief and functional disability. In all endpoints, sumatriptan, 100 mg, was significantly superior to placebo.
What OTC medication has been shown to be effective for tension type headaches ?
in short paracetamol and ibuprofen were effective at treating headache pain within 2 hours. ibuprofen more so than paracetamol. Aspirin had very little evidence
Codiene may provide relief but may be unnecessary and should only be used for 3 days.
Sumatriptan Sumatriptan was the first triptan to be marketed in the UK and, subsequently, deregulated to OTC status. Triptans are 5-HT1 agonists and stimulate 5-HT1B and 5-HT1D receptors. Triptans cause constriction of the cranial blood vessels, stop the release of inflammatory neurotransmitters at the trigeminal nerve synapses, and reduce pain signal transmission. As a class of medicines, they have been extensively researched. Most trials with sumatriptan (and other triptans) use endpoint data of a 2-hour pain-free response, headache relief and functional disability. In all endpoints, sumatriptan, 100 mg, was significantly superior to placebo.
