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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
Q

What is indication of triptans?

A

Acute migraine attacks

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26
Q

How to take triptans?

A

1 dose ASAP after onset.

2nd dose 2 hours LATER

27
Q

How to take naratriptan?

A

take 2nd dose 4 hours after 1st dose.

Do not take 2nd dose for same attack if no response.

28
Q

What is 1 SE of triptans?

A

coronary vasoconstriction

29
Q

What signs mean you need to stop triptains?

A

Stop if heat, tightness in chest or throat

30
Q

What are 4 contra-indications of triptan use?

A

not used for patients with MI, angina, stroke, moderate to severe or uncontrolled HTN

31
Q

What drug classes can interact with triptans to increase risk of serotonin syndrome?

A

antidepressants, Lithium , MAO-B inhibitors, methadone, st john’s wort, triptans, tramadol, anfetamines

32
Q

What is a cluster headache?

A

sharp, burning or piercing pain, usually on 1 side of the head, around the eye

33
Q

What is 1st line treatment for cluster headache?

A

Sumatriptan given by SC injection

34
Q

What route is Sumatriptan given for cluster headaches?

A

SC

35
Q

What 2 triptans can be used in patients with early vomiting or have severe migraine attacks?

A

sumatriptan nasal spray OR zolmitriptan nasal spray [both unlicensed use]

36
Q

What is a way of preventing attack of cluster headache?

A

100% oxygen at a rate of 10–15 litres/minute for 10–20 minutes is useful in aborting an attack.

37
Q

What 3 conditions is prophylaxis of cluster headache considered?

A

if the attacks are frequent,
Or

If they last OVER 3 weeks

Or

if they cannot be treated effectively.

38
Q

what 2 unlicensed drugs are used for prophylaxis of cluster headaches?

A

Verapamil hydrochloride OR lithium [both unlicensed use]

39
Q

What unlicensed drug is used for short-term prophylaxis of episodic cluster headache?

A

Prednisolone - mono-therapy OR dual with verapamil during verapamil titration.

40
Q

What type of patients is sumatriptan contra-indicated in?

A

uncontrolled hypertension, heart patients

41
Q

What is trigeminal neuralgia?

A

Severe facial pain - electric shock like feeling in jaw , teeth gums

Treat with carbemazepine

42
Q

What is tension headache?

A

Bilateral throbbing pain like tight band on head

paracetamol or ibuprofen

43
Q

When to take the triptan for migraine?

A

As soon as patient gets migraine and before aura starts unless it starts at same time

44
Q

When to give second dose of triptan?

A

Only if 1st dose positively somewhat worked

45
Q

What other drug can be considered other than propranolol for migraine prophylaxis, especially if they have episodic or chronic migraine?

A

Amitriptyline

Can use less sedating one too.

46
Q

What is max sumatriptan dose for migraines?

A

300mg per day

47
Q

Why should metoclorpramide not be used regularly?

A

Risk of EPS

48
Q

Which anti-hypertensive can be considered unlicensed for prophylaxis of migraines but NOT in pregnancy?

A

Candesartan

49
Q

What can be given instead of, or in addition to, standard prophylactic treatment in women with perimenstrual migraine?

A

Frovatriptan

50
Q

For treatment to be effective in women with perimenstrual migraine, what should happen?

A

Periods must be regular

51
Q

What is recommended for prophylaxis of chronic migraine where medication-overuse has been addressed + where 3 + oral prophylactic treatments have failed?

A

Botox A- specialist use

52
Q

What 2 sections are episodic migraine further divided into?

A

Low frequency

High frequency

53
Q

How many days is high frequency?

A

10-14 days per month

54
Q

How many days is low frequency?

A

1-9 days per month

55
Q

What is lifestyle advice for migraines?

A

Eat rreg meals, drink enough, sleep + exercise

Avoid triggers

Headache diary - min of 8 weeks

56
Q

What Pain relief suppository is used to help with severe N+ V?

A

Diclofenac

57
Q

What combo therapy is given for migraines if monotherapy fails?

A

Sumatriptan and naproxen

58
Q

What ARB can be considered as prophylactic treatment for migraines?

A

Candesartan - NO in pregnancy

59
Q

What drug is considered in patients over 55+ years for migraine?

A

Sodium valproate

60
Q

How long should preventative treatment be tried for at least?

A

3 months at max tolerated dose.

61
Q

What is a good response to treatment defined as?

A

50% reduction in severity/freq of migraine attacks

62
Q

When should patients be referred to neurology with migraine?

A

If tried 3 or + drugs and not worked.

63
Q

What is a cautionary label for triptains?

A

Can make you sleepy, if happens do not drive or use machines.

PRE-REG-Thuri (44 decks)

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