headache & migraines

• Tension headache

  Most common type, persistent dull pain around the base of the skull/ upper part of the neck, can extend to top of the head/ above the eyes, "band around the head" - common wording used, NO NECK STIFFNESS!
• Tension headache causes?

  
  

  stress, anxiety, bad posture, tiredness, eye strain
• Migraine

  Unilateral (affecting one side) of the head/ especially over the forehead, can be preceded by aura (change in vision/ tingling/ numbness on one side of the body, symptoms can include: nausea, vomiting, photosensitivity
• Sinus headache

  Build up of pressure in sinuses (during/after cold)
• Cluster headache

  Severe pain on one side of the head/ occurs randomly over 6-12 weeks
• Analgesics

  Paracetamol, Ibuprofen, Aspirin
• Ibuprofen LYSINE

  Absorbed quicker than regular ibuprofen
• Opiates

  Codeine (co-codamol 8/500mg, Solpadeine preparations, Nurofen Plus), Dihydrocodeine - (Paramol)
• Opiates

  • Side effects: drowsiness, respiratory depression, constipation/addiction (have a break after 3 days use)
• Anti-emetics

  Buccastem (contains prochlorperazine), buccal route preferred as gastric emptying delayed during a migraine, Migraleve (Pink tablet contains bucclizine)
• Sumatriptan

  >18-65 yrs

  >For acute relief of migraine attacks, with/without aura, only for patients with previous diagnosis of migraine by GP/ not for prophylactic use, established migraine attacks (>5 attacks per year)

  >contraindicated: cardiovascular conditions, hypertension, peripheral vascular disease, liver/kidney disorders, neurological conditions (epilepsy)
• Sumatriptan dosage

  1 tablet (50mg) at onset of migraine, another dose can be taken after 2hrs for another attack, Maximum of 2 tablets in 24 hours
• referrals for sumatriptan?

  24hr headache

  4 or more attacks in a month
• counselling for headache/migraine

  daily use of analgesics can cause chronic daily headaches

  take regular breaks if using computer screen/sitting in one position

  regular exercise/relaxation can help prevent stress related headaches
• Headaches/migraines REFER

  >first migraine occuring >40yrs of age

  >frequent migraines (>5 days a month)

  >recurring headaches (suspect medication overuse headache )

  > taking contraceptive (suspect thromboembolism)

  > neck stiffness (suspect meingitis)

  > headaches in child <12yrs

  > severe headache more than 4 hours
• red flags headaches/migraine that prompt to RING 999!!!

  > headache with high temp, neck stiffness, mental confusion, seizures, double vision, rash ( suspect meninigitis)

  > slurred/garbled speech, paralysis/weakness in one or both arms/or on one side of the face (suspect stroke)