Headache

Question 1

what questions would you ask a pt suffering from a headache?

Answer 1

• Onset of action
• Frequency and timing (menstrual cycle)
• location of pain (cluster - unilateral in frontal and ocular areas, migraine - unilateral but changes from side to side, tension type - bilateral
• severity of pain - subjective, throbbing, dull, piercing, boring, searing eye pain
• Triggers - exertion, coughing, bending, food, menstruation
• Attack duration - migraine lasts between a few hours and 3 days, tension-type headaches - few hours and several days, cluster lasts 2-3 hours
• associated symptoms like fever - infections

Question 2

What are the symptoms of tension-type headache?

Answer 2

• Tightness or weight pressing down on their head and upper neck sometimes extends to the top of the head and back of the eyes
• Not associated with neck stiffness or N/V
• Headaches last 30minutes - up to 7 days

Question 3

What symptoms are associated with migraines?

Answer 3

unilateral - affecting one side of the head, over the forehead
alterations in vision or tingling/numbness on one side of the body, in the lips, fingers or hands before an attack starts
N/V and photosensitivity
mood changes, poor concentration, food cravings
headache with or without aura
lethargic , tired, drained

Question 4

How long do migraine attacks last for?

Answer 4

4-72 hours

average length is 24 hours

Question 5

What can possibly trigger migraine attacks?

Answer 5

stress, diet, cheese, citrus fruits, chocolate
maintain a food diary
maintain regular sleep pattern
regular exercise

Question 6

What can occur in pt that have a migraine with aura (classic migraine)?

Answer 6

blind spots, zig-zag lines, flashing or flickering lights
throbbing
pins and needles going up the arm
photophobia

Question 7

What can be used to treat cluster headache?

Answer 7

sumatriptan or verapamil

Question 8

What are the symptoms of meningitis?

Answer 8

severe generalised headache, fever, neck stiffness, N/V, purpuric rash, if a child has difficulty placing their chin on their chest and is running a temperature above 38.9 - urgent referral

Question 9

When would you refer pts that present with headache?

Answer 9

1. First migraine episode occurring over the age of 40
2. Any headache that does not respond to OTC analgesics within a day
3. Dull pain that is deep seated and severe and aggravated by lying down or worse in the morning - intracranial pressure derived from tumour
4. headaches of increasing frequency and severity
5. recurring headache can indicate medication-induced headache (overuse)
6. any woman taking COC
7. severe headache of more than 4 hours duration
8. headache in children under 12 years
9. neck stiffness
10. headache following on from recent injury or trauma

Question 10

What tx options can be given for pts with tension and migraine headaches?

Answer 10

Paracetamol
NSAIDS
Analgeic combo’s containing opioids e.g. codeine, dihydrocodeine - cant use in tension headaches
Sumatriptan

Question 11

what are the side effects that can occur?

Answer 11

• Daily use of analgesics can cause chronic daily headache so short term use only
• drowsiness
• respiratory depression
• constipation
• addiction

Question 12

Name some OTC tx

Answer 12

Nurofen, Migraleve, Imigran, Paracodol, Solpadeine

Question 13

What age group can migraleve and midrid? What side effects are associated? Interactions ?

Answer 13

> 12 years
Migraleve: dry mouth, sedation, constipation
interacts: alcohol, opioids, anxiolytics, hypnotics, antidepressants
glaucoma, prostrate enlargment

Midrid: dizziness, rash, avoid pts taking MAOIs - hypertensive crisis, avoid in pts taking BB and TCAs
careful in pts that have HTN and diabetes - short term is fine

Question 14

How does sumatriptan work?

Answer 14

constricts the cranial blood vessels, stops the release of inflammatory neurotransmitters at the trigeminal nerve synapses and reduce pain signal transmission

Question 15

What are the age restrictions of sumatriptan? when can it be used? when shouldnt it be used?

Answer 15

18-65 years
only use if clear diagnosis of migraine
dont use prophylactically

Question 16

Which pts should sumatriptan (imigran) should not be given to?

Answer 16

those with cardiovascular conditions, HTN, peripheral vascular disease, liver or kidney disorders, neurological conditions, epilepsy

Question 17

what are the side effects of sumatriptan?

Answer 17

dizziness, drowsiness, warm, flushed or weak sensation of heaviness in any part of the body, pressure in the throat, neck chest arms legs, SOB

Question 18

When should sumatriptan be taken? can two tablets be taken?

Answer 18

one 50mg tablet should be taken ASAP after onset of attack.
A second dose may be taken after 2 hours if migraine recurs. If there is no response to the first tablet, a second tablet should not be taken for the same attack.

Question 19

What is the maximum dosage of sumatriptan?

Answer 19

max two tablets in 24 hours and the pt should not take any concurrent medication for migraines

Question 20

What is Buccastem? What is it used for?

Answer 20

Prochlorperazine
potent antiemetic - blocks dopamine receptors found in the chemoreceptor triggering zone

indicated for migraine sufferers >18 years one or two tablets daily

Question 21

what are the side effects that can occur with buccastem? interactions?

Answer 21

drowsiness, dry mouth, dizziness
alcohol - because it crosses BBB
also interacts with opioid analgesics, anxiolytics, hypnotics, antidepressants

Question 22

how would you administers the buccal tablet?

Answer 22

place between upper lip and gum
allow tablet to dissolve slowly
3-5 hours to dissolve completely
do not chew

Question 23

Peristalsis is reduced when a pt has a migraine attack, what can you recommend?

Answer 23

soluble or orodispersible tablets to maximise absorption