Migraine.

 

Definition:

A migraine is defined as a severe, pulsating headache, which may also be associated with other

symptoms, such as nausea and photophobia. People may experience them regularly- up to several

times a week, or only very occasionally. 

 

 

Causes:

Although not known for sure, it is thought that migraine may be due to changes in chemical levels

in the brain- it has been identified that serotonin levels decrease during a migraine. These low levels

may cause blood vessels to contract, which is thought to be the reason behind the aura (which is a

warning sign experienced before the actual headache) . When the blood vessels dilate again, it

could cause the headache to occur.

 

Certain triggers may cause the migraine such as certain food and drink (cheese, red wine), changes

in routine (tiredness), hormonal changes, emotional changes, external factors (bright, flickering

lights), dental pain or medicines (for example, some oral contraceptives).

 

 

Presentation:

The headache should be desribed as a throbbing pain, will be unilateral (on one side of the head),

and last from 4-72 hours. If the migraine is severe or recurrent (more than one per month) then

POM medication is required.

 

It may be preceded by an aura. Symptoms of an aura may include visual disturbances; such as

flashing lights or blind spots, stiffness or tingling in the neck, shoulders or limbs or problems with

co-ordination or speaking. Generally, an aura appears around 15 minutes before the migraine-

patients should use this indication to get medication or to get home.

 

In addition, other symptoms may be present, such as nausea and vomiting, photophobia and

phonophobia.

 

 

Differential Diagnosis:

Headache should be of moderate to severe intensity.

 

Will be aggravated by physical activity.

 

Ensure it is unilateral and of a pulsating or throbbing quality, otherwise it may be a different type of headache (such as tension headache).

 

Check there has been no recent head trauma.

 

If a person if suffering from regular migraines they should be referred to a doctor to try to identify the cause, and to get prescription medication.

 

 

Treatment:

Paracetamol may be used to combat pain, TWO tablets should be taken up to FOUR times daily (every 4 to 6 hours), 

 

Co-codamol may be used if paracetamol does not resolve the pain. TWO tablets should be taken FOUR times

daily, maximum of EIGHT per day.

 

Other treatment options also include an anti-emetic such as prochlorperazine. ONE or TWO of the 3mg tablets

should be placed in the buccal cavity TWICE a day.

 

In addition, sumatriptan (a 5HT1 agonist) can be given in the event of a migraine, however specific criteria must

be fulfilled before this is dispensed.

 

 

Self Help Advice:

Get eyes tested regularly.

 

Regular exercise and relaxation techniques can help prevent headaches.

 

Take regular breaks when using a computer.

 

Keep a diary to help determine patterns or triggers.

 

Ensure regular dental check ups.

 

 

Sample Question:

A young woman visits your pharmacy to ask you to recommend something that she can buy to treat nausea and vomiting associated with migraine. Given that she has previously had migraine diagnosed by a doctor, that she is otherwise well and is not allergic to any medicines, which one of the following would it be most appropriate for you to recommend?

 

 

A Sea-legs (meclozine hydrochloride) tablets

B Stugeron (cinnarizine) tablets

C Buccastem M (prochlorperazine maleate) buccal tablets

D Joy-rides (hyoscine hydrobromide) tablets

E Avomine (promethazine teoclate) tablets

 

 

Answers to all sample questions can be found by following the link under the Test Yourself tab.