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Headache, Migraine - Coggle Diagram
Headache
Migraine
Treatment
Rest in a quiet dark room for sensitive to sounds and light
Aspirin, Ibuprofen, Paracetamol
recommended
Paracetamol + Metoclopramide
available for N/V migraine but care for EPSE
Ondensetron is effective but needs prescription
Oral triptan
is used as 2nd line if simple analgesics are ineffective
Naratriptan
may not be very effective due to long onset of action
GI stasis can be countered by using subcut, patch or nasal delivery
Recurrence
Triptan dose can be repeated, mainly after 2hrs except Naratriptan due to longer half life thus after 4hrs.
Pregnancy
Paracetamol
first, only if not working, use
Sumatriptan
. Sumatriptan has more data on use with pregnancy and thus "safer" than other triptans for first trimester. Later on, 2nd and 3rd trimester, not much difference in malformations
Side effects and cautions
Triptans: Contradindicated in uncontrolled HTN, Hx of IM, IHD or vasospasms due to potential vasoconstriction.
Potential serotonin syndrome thus care with other serotonergic drugs liek SSRIs, SNRIs, TCAs, MAOIs, tramadol etc.
Excessive use of analgesic medications can also cause migraines and headaches.
TCAs:
Sedation and ACh effects
Pizotifen
: Weight gain, sedation, nausea, mild ACh effects
Topiramate:
Somnolence, dizziness, psychiatic effects, weight loss, leucopenia
Main ADRs: Nausea, dizziness and somnolence are very similar across the board
Menstrual Migraine
Increase risk of stroke for those with continous cycling of estrogen or COCP
Prevention
Prophylactic therapy consider when migraine occur >2 times a month.
Many first line drugs:
Amitriptyline, Candesartan, Nortriptyline, Pizotifen, Propranolol, Topiramate.
All equal effect, max effect at 8 weeks, all similar side effect profiles.
Botox:
Injected into specific sites for prevention
Classification
Lasting 4-72hrs, one-sided, pulsing pain, sensitive to light and sound.
Can have or not have aura
Aura:
visual disturbance such as lights, spots loss vision, or dizziness before or at onset of migraine.
Can have N/V and GI stasis
Menstrual Migraine
Predicted
to occur during
low estrogen levels
, thus prophylaxis using
Ibuprofen, Naproxen or Naratriptan
at times just before low estrogen level.
Oestrogen
can be used aswell at the specific time.