Pregunta 1
Pregunta
Headache epidemiology:
• Most common form of [blank_start]pain[blank_end]
• 1 in 10 people get [blank_start]migraines[blank_end], more common in women.
• Migraines usually first occur between the ages of 10-30, and may get [blank_start]better[blank_end] in middle age.
• Estimated that almost half of the adult population have had a headache at least once within the last year.
• Associated with pain, disability, damaged quality of life, and financial cost. Global Burden of Disease – 3rd and 6th
Pregunta 2
Pregunta
Types of headache:
• [blank_start]Tension[blank_end] headache. Most common type
• Medication overuse headache. Also known as “[blank_start]rebound[blank_end]”
• Sinus headache
• Migraine (with or without aura). 70-90% experience migraine [blank_start]without[blank_end] aura
• [blank_start]Cluster[blank_end] migraine. Extremely disabling
• Others – including high altitude headache, menstrual migraine and
chronic migraine
Respuesta
-
Tension
-
rebound
-
without
-
Cluster
Pregunta 3
Pregunta
Menstrual migraine
• Tend to be particularly [blank_start]severe[blank_end]
• Self help tips:
1.Eat small, [blank_start]frequent[blank_end] snacks to keep your blood sugar level up.
2.Have a [blank_start]regular[blank_end] sleep pattern.
3. Avoid [blank_start]stress[blank_end].
Respuesta
-
severe
-
frequent
-
regular
-
stress
Pregunta 4
Pregunta
Which of these is not a migraine trigger?
Respuesta
-
Stress/anxiety
-
Excitement
-
Fatigue
-
Poor posture
-
Low blood sugar
-
Bright lights
-
HRT, COC
-
Alcohol
Pregunta 5
Pregunta
Location of pain:
Sinus - [blank_start]sinuses, face[blank_end]
Tension - [blank_start]band around forehead[blank_end]
Migraine - [blank_start]one sided[blank_end]
Cluster - [blank_start]around one eye[blank_end]
Respuesta
-
sinuses, face
-
band around forehead
-
one sided
-
around one eye
Pregunta 6
Pregunta
Which of these is not a differential diagnosis for headaches?
Respuesta
-
Subarachnoid haemorrhage (SAH)
-
Systemic or central nervous system (CNS) infection
-
Ischaemic stroke
-
Premenstrual syndrome (PMS)
Pregunta 7
Pregunta
Medication overuse (rebound):
It may feel like a tension-type headache or migraine-like attack.
Headaches often improve within [blank_start]2 to 4 weeks[blank_end] of withdrawal of the
overused medicine but can feel [blank_start]worse[blank_end] before improvement is seen.
• To avoid this, limit the use of pain relief medication:
- Paracetamol and NSAIDs should not be taken for headache on more than [blank_start]15[blank_end] days per month
- Triptans for migraine should not be used for more than [blank_start]10[blank_end] days per month
Pregunta 8
Pregunta
Migraine without aura can cause nausea and vomiting.
Pregunta 9
Pregunta
Which of these is NOT a symptom of Migraine with aura?
Pregunta 10
Pregunta
Cluster migraine
• A [blank_start]rare[blank_end] type of headache that affects about 1 to 2 people in every 1,000
• They can happen [blank_start]several[blank_end] times a day for a period of time, then disappear for [blank_start]months[blank_end] or years.
• Try to identify the triggers and avoid those things.
Pregunta 11
Pregunta
Pain relieving medicines (for immediate relief):
• Paracetamol (liquid or soluble)
• NSAIDs e.g. ibuprofen, diclofenac, naproxen
• Opioids – [blank_start]codeine[blank_end] (pharmacist only)
• [blank_start]Triptans[blank_end] - rizatriptan, sumatriptan, zolmitriptan
Medicines for nausea/ vomiting:
[blank_start]• Metoclopramide• Prochlorperazine[blank_end]
• Medicines to prevent migraines
• Beta blockers - [blank_start]propanolol[blank_end]
• [blank_start]Amitriptyline, nortriptyline[blank_end] (TCAs)
• Sodium valproate, gabapentin, topiramate
• Verapamil, oxygen
• Botulinum toxin type A
• Pizotifen
• [blank_start]Transcranial magnetic stimulation[blank_end] (TMS)
• Acupuncture
Respuesta
-
codeine
-
Triptans
-
• Metoclopramide • Prochlorperazine
-
propanolol
-
Amitriptyline, nortriptyline
-
Transcranial magnetic stimulation
Pregunta 12
Pregunta
A pharmacist can sell [blank_start]sumatriptan[blank_end] OTC when sold in the [blank_start]original[blank_end] pack, containing [blank_start]two[blank_end] or less tablets (of [blank_start]50mg[blank_end] or less per tablet) for [blank_start]acute[blank_end] relief of migraine [blank_start]with or without[blank_end] aura.
Respuesta
-
sumatriptan
-
original
-
two
-
50mg
-
acute
-
with or without
Pregunta 13
Pregunta
Which of these is NOT a side effect of triptans?
Pregunta 14
Pregunta
Red flags
• A really severe headache that comes on [blank_start]suddenly[blank_end] and gets [blank_start]worse[blank_end] within minutes (especially if over [blank_start]50[blank_end] years old)
• Changes in your [blank_start]vision[blank_end] or eye sight or changes in consciousness
• feeling sick (nausea), a stiff [blank_start]neck[blank_end], rash, fever, shakes or sensitivity to [blank_start]light[blank_end]
• [blank_start]Red[blank_end] eye, feeling sick (nausea) or being sick (vomiting)
• Headache following a [blank_start]head injury[blank_end].
Respuesta
-
suddenly
-
worse
-
50
-
vision
-
neck
-
light
-
Red
-
head injury