Migraine Flashcards

1
Q

Define migraine and associated symptoms

A
  • Severe headache
  • nausea, vomiting, visual disturbances and increased sensitivity to light or sound
  • 2/3 of patients are women
  • pain is of dull nature, throbbing and pounding
  • two types of migraine
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2
Q

What are the 2 types of migraine?

A

Common - 75% = migraine without aura

Classic= migraine with aura

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3
Q

Treatment timescale of migraine

A

With treatment should resolve within 1 day

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4
Q

Symptoms of classic migraine

A
  • unilateral, affecting ONE side of the head, especially over the forehead
  • alterations in vision before attack starts (prodromal phase)
  • Tingling/numbness on one side of the body, lips, finger, face or hands
  • Nausea and vomiting
  • bright lights hurt eyes during attack
  • relief via lying down in dark room
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5
Q

Symptoms of a common migraine

A
  • no prodromal phase (no aura)
  • nausea and vomiting
  • increased sensitivity like light, sound, smell
  • headache may be one-sided, but both sides can be affected
  • rest in a dark room
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6
Q

Referral criteria of migraines

A
  • severe and >4hrs duration
  • ADRs
  • Children under 12yrs
  • associated with head injury/trauma
  • associated drowsiness, unsteadiness, visual disturbances, vomiting
  • severe occipital pain across back of head and raised intracranial pressure i.e. deep-seated, severe and aggravated by lying down
  • pain worse in morning and improved during the day
  • nausea and vomiting
  • neck stiffness
  • frequent migraines or persistent headaches
  • any woman taking the COC should be referred
  • sudden severe pain at the back of the head- may signify subarachnoid haemorrhage (SAH) where a small blood vessel in brain leaks blood into CSF. May be due to high BP. Refer
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7
Q

Lifestyle advice for migraines

A

Stress
Certain foods
Hormonal changes (menses)
get eyes checked

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8
Q

Migraleve pink
APIs
symptoms

A

Co-codamol
Buclazine
Migraine

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9
Q

Migraleve pink contraindictions

A

In all paediatric patients (0 to 18 years of age) who undergo tonsillectomy and/or adenoidectomy for Obstructive Sleep Apnoea Syndrome due to an increased risk of developing serious and life-threatening adverse reactions (see section 4.4).

Head injury; in conditions in which intracranial pressure is increased; acute respiratory depression; obstructive bowel disorders and in patients at risk of paralytic ileus.

In women during breastfeeding (see section 4.6).

In patients for whom it is known they are CYP2D6 ultra-rapid metabolisers.

Migraleve tablets are contraindicated for children below 12 years of age

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10
Q

Migraleve pink populations and warnings

A

can only use for 3 days
can cause addiction
>12yrs only
Not suitable in pregnancy or breastfeeding

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11
Q

Treatments for migraine

A

Simple analgesics - Paracetamol, Ibuprofen
Migraleve (yellow/pink)
Imigran
Sumatriptan

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12
Q

Migraleve yellow

API and symptoms

A

co-codamol
Short term treatment of acute moderate pain which is not relieved by other analgesics
e..g migraine

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13
Q

Imigran nasal spray side effects

A

Dizziness
Drowsiness
sensory disturbance including parasthesia and hypoaesthesia
Dysgeusia/unpleasant taste

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14
Q

Imigran nasal spray API and what it does

A

Sumatriptan 10mg

Suppresses cough and helps you to sleep at night

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15
Q

warnings for imigran nasal spray

A

> 12yrs only

do not use in pregnancy or breastfeeding

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16
Q

Contraindications for imigran nasal spray

A

MI, IHD, coronary vasospasm, peripheral vascular disease
Symptoms suggestive of IHD
Not in history of TIA (transient ischaemic attack) or CVA (cerebrovascular accident)
Severe hepatic impairment
Hypertension
MAOIs - Imigran must not be used within 2 weeks of discontinuation of therapy with monoamine oxidase inhibitors
-ergotamine, or derivatives of ergotamine (including methysergide) or any triptan/5-hydroxytryptamine1 (5-HT1) receptor agonist is contraindicated

17
Q

Imigran nasal spray directions

A

18 yrs or older:
Optimal dose=20mg in nose nostril. If patient doesn’t respond to first dose, another should NOT be taken for the same attack
No more than 2 doses of Imigran 20mg nasal spray in 24 hours

12-17 years of age:
10mg in one nostril. do NOT take 2nd dose for same attack.
If symptoms recur, can have 2nd dose but must be minimum of 2 hours between the two doses.
Maximum of 2 doses of 10mg in any 24 hour period