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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

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