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Migraine<br />
Migraines are a type of severe headache, and one of the most common headache<br />
disorders seen by doctors, occurring in 18% of women and 6% of men.<br />
Symptoms of a migraine differ from other types of headache (see Headache).<br />
Migraine attacks are typically unilateral (only one side of the head is affected),<br />
although occasionally bilateral migraines (both sides of the head) occur. The pain is<br />
usually described as a dull throb or tightening which intensifies into a concentrated<br />
and severe pain. Most people feel sick; however, only about 30% will vomit. The exact<br />
cause of migraines is unknown, but chemical and vascular changes within the brain<br />
as well as strong genetic factors are thought to play a role.<br />
An aura – which may take the form of a funny smell, taste, feeling or visual<br />
disturbance – is experienced by almost one quarter of people with migraine.<br />
This may be present for up to an an hour before the headache starts. Migraine<br />
sufferers may also have difficulty seeing or speaking. Other common symptoms<br />
that occur in addition to the pain of migraine include:<br />
• osmophobia (sensitivity to smells)<br />
• phonophobia (sensitivity to noise)<br />
• photophobia (sensitivity to light)<br />
• visual disturbances (blurred vision, flashes of light, zigzag lines, blind spots)<br />
• weakness, numbness or tingling in the face, arm or leg<br />
• yawning, sleepiness, lack of energy.<br />
Migraines can last from four hours to two or three days and may occur once a<br />
year to once every few days. Most people have a family history of migraine. First<br />
attacks often occur in adolescence, and attacks tend to become less severe and<br />
less frequent with age.<br />
Migraine attacks can substantially impair a person's functioning during an<br />
attack. Research has shown quality of life is also diminished between attacks.<br />
Initial assessment<br />
Ask your customer to "Tell me about your headache", and listen to their<br />
response. A headache is more likely to be a migraine if nausea and/or vomiting<br />
TREATMENT OPTIONS<br />
Category Examples Comments<br />
Simple analgesics<br />
Non-steroidal antiinflammatory<br />
drugs (NSAIDs)<br />
Combination analgesics<br />
Antiemetics<br />
Serotonin (5-HT) receptor<br />
agonists<br />
Natural / herbal products /<br />
supplements<br />
[GENERAL SALE] eg, paracetamol (Panadol<br />
range, Paracare)<br />
[GENERAL SALE]<br />
eg, aspirin (Aspro, Disprin range), ibuprofen up<br />
to 25s (Advil, Nurofen Migraine Pain, Nurofen<br />
Zavance)<br />
[PHARMACY ONLY MEDICINE]<br />
eg, diclofenac (Voltaren Rapid 12.5), ibuprofen<br />
>25s (Advil, Nurofen range), naproxen<br />
(Sonaflam)<br />
[PHARMACIST ONLY]<br />
eg, diclofenac (Voltaren Rapid 25)<br />
[GENERAL SALE] eg, ibuprofen + paracetamol<br />
(Maxigesic [16], Nuromol [12])<br />
[PHARMACY ONLY MEDICINE] eg, ibuprofen<br />
+ paracetamol (Maxigesic [50, 100], Nuromol<br />
[24])<br />
[PHARMACIST ONLY MEDICINE]<br />
eg, paracetamol + codeine (Panadeine,<br />
Panadeine Extra), ibuprofen + codeine (Ibucode<br />
Plus, Nurofen Plus), paracetamol + doxylamine<br />
+ codeine (Mersyndol*)<br />
[PHARMACIST ONLY MEDICINE]<br />
eg, prochlorperazine (Antinaus)<br />
[PHARMACIST ONLY MEDICINE]<br />
eg, sumatriptan 50mg (Sumagran Active),<br />
zolmitriptan nasal spray 5mg (Zomig)<br />
5-HTP, caffeine, butterbur, coenzyme Q10,<br />
feverfew, magnesium, riboflavin (Clinicians<br />
MigraDol)<br />
Generally effective at relieving mild-type pain. May not be strong enough as the sole<br />
analgesic for migraine. Few adverse effects.<br />
Products with an asterisk have a detailed listing in the Migraine section of OTC Products, starting on page 250.<br />
NSAIDs generally last longer than paracetamol. Ibuprofen is the NSAID least likely to cause<br />
stomach irritation. NSAIDs may not be suitable for people on certain other medications or<br />
with some medical conditions (eg, asthma, kidney disease – see Refer to Pharmacist).<br />
Advise customer to stop taking if stomach upsets, increased bruising or prolonged bleeding<br />
occur. Aspirin products require the same warnings as other NSAID products. Aspirin is not<br />
recommended for adolescents or children under 12 years old, or for children under 16 years<br />
old with a viral-related fever, or fever with chickenpox (see Childhood Pain and Baby<br />
Teething: Treatment options).<br />
See also Reference Section, OTC Medicines – Precautions.<br />
Try paracetamol or NSAIDs first.<br />
Warn customers that codeine is an addictive substance and should not be used for more than<br />
three days at a time. Constipation or drowsiness may also occur. Monitor sales and be alert<br />
for any customers who may be misusing codeine-containing preparations.<br />
Mersyndol also contains doxylamine, so can cause drowsiness.<br />
Can be sold by a pharmacist in quantities of 10 or fewer tablets for nausea associated with<br />
migraine.<br />
Proven effectiveness in migraine. Small packs may be sold by a pharmacist for adults with<br />
a stable, well-established pattern of migraine symptoms for relief of acute attacks. Follow<br />
packet instructions strictly.<br />
Caffeine in combination with analgesics is effective at treating migraine. Other supplements<br />
may be more effective for preventing migraines when taken daily for at least three months.<br />
Significant learning<br />
opportunity: Wound care<br />
Your new Group 3 CPD project<br />
Page 106 HEALTHCARE HANDBOOK <strong>2017</strong>-2018 Common Disorders