NE6 Headache

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

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

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].

Which of these is not a migraine trigger?

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]

Which of these is not a differential diagnosis for headaches?

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

Migraine without aura can cause nausea and vomiting.

Which of these is NOT a symptom of Migraine with aura?

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.

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

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.

Which of these is NOT a side effect of triptans?

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].