Podcast
Questions and Answers
Which group of individuals is at increased risk of complications if they experience migraines?
Which group of individuals is at increased risk of complications if they experience migraines?
What is considered a criteria for diagnosing medication overuse headache?
What is considered a criteria for diagnosing medication overuse headache?
Which condition cannot be treated with sumatriptan according to the guidelines?
Which condition cannot be treated with sumatriptan according to the guidelines?
What symptom indicates a change requiring medical evaluation for patients with a history of migraines?
What symptom indicates a change requiring medical evaluation for patients with a history of migraines?
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Which scenario represents a significant contraindication for combined oral contraceptive use in women suffering from migraines?
Which scenario represents a significant contraindication for combined oral contraceptive use in women suffering from migraines?
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Which factor is least likely to require referral for a muscular injury?
Which factor is least likely to require referral for a muscular injury?
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Which type of pain is predominantly associated with nerve root compression?
Which type of pain is predominantly associated with nerve root compression?
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In which patient demographic is the risk of osteoporosis primarily increased?
In which patient demographic is the risk of osteoporosis primarily increased?
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What is a recommended treatment approach for acute soft-tissue injury?
What is a recommended treatment approach for acute soft-tissue injury?
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What is the most common misconception regarding the use of arnica for bruising?
What is the most common misconception regarding the use of arnica for bruising?
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What symptom predominantly indicates a possible serious back pain condition in patients under 15 years?
What symptom predominantly indicates a possible serious back pain condition in patients under 15 years?
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Which of the following is NOT a consideration for diagnosing back pain?
Which of the following is NOT a consideration for diagnosing back pain?
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Which of these is NOT a key component of the WWHAM questioning method?
Which of these is NOT a key component of the WWHAM questioning method?
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What is the primary treatment option recommended for tension headaches?
What is the primary treatment option recommended for tension headaches?
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Which symptom would indicate the need for immediate referral regarding a headache?
Which symptom would indicate the need for immediate referral regarding a headache?
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What symptom would most likely require referral for back pain management?
What symptom would most likely require referral for back pain management?
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Which of the following is NOT considered effective treatment for primary dysmenorrhoea?
Which of the following is NOT considered effective treatment for primary dysmenorrhoea?
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What is a common trigger for tension headaches?
What is a common trigger for tension headaches?
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In which situation should a referral for primary dysmenorrhoea definitely be considered?
In which situation should a referral for primary dysmenorrhoea definitely be considered?
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What characteristic is NOT typically associated with migraine headaches?
What characteristic is NOT typically associated with migraine headaches?
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Which vitamin is mentioned as a possible aid for headache relief?
Which vitamin is mentioned as a possible aid for headache relief?
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What clinical feature is often associated with the onset of primary dysmenorrhoea symptoms?
What clinical feature is often associated with the onset of primary dysmenorrhoea symptoms?
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Which factor would not typically indicate the need for referral in chronic back pain cases?
Which factor would not typically indicate the need for referral in chronic back pain cases?
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What duration of headache requires consideration for referral?
What duration of headache requires consideration for referral?
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What symptom is typical of a tension headache?
What symptom is typical of a tension headache?
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What is a common characteristic of primary dysmenorrhoea?
What is a common characteristic of primary dysmenorrhoea?
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Which of the following is least likely to improve symptoms of acute back pain?
Which of the following is least likely to improve symptoms of acute back pain?
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For migraines, which symptom is most commonly reported?
For migraines, which symptom is most commonly reported?
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What shared feature is found in both sciatica management and primary dysmenorrhoea treatment?
What shared feature is found in both sciatica management and primary dysmenorrhoea treatment?
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Which of the following is NOT a recommended treatment for tension headaches?
Which of the following is NOT a recommended treatment for tension headaches?
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Which symptom can be indicative of a condition that warrants immediate referral in sciatica cases?
Which symptom can be indicative of a condition that warrants immediate referral in sciatica cases?
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What is typically NOT a recognized trigger for migraines?
What is typically NOT a recognized trigger for migraines?
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What is a common misconception regarding primary dysmenorrhoea symptoms?
What is a common misconception regarding primary dysmenorrhoea symptoms?
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Which symptom is NOT typically associated with a migraine?
Which symptom is NOT typically associated with a migraine?
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What is the maximum dosage of Sumatriptan within a 24-hour period for an adult?
What is the maximum dosage of Sumatriptan within a 24-hour period for an adult?
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What is the primary mechanism of action of triptans like Sumatriptan?
What is the primary mechanism of action of triptans like Sumatriptan?
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Which of the following is NOT a content of the pink tablet of Migraleve®?
Which of the following is NOT a content of the pink tablet of Migraleve®?
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What is the purpose of assessing cardiovascular risk before supplying Sumatriptan OTC?
What is the purpose of assessing cardiovascular risk before supplying Sumatriptan OTC?
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Which side effect is commonly associated with Sumatriptan?
Which side effect is commonly associated with Sumatriptan?
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What symptoms might indicate an overdose of Sumatriptan?
What symptoms might indicate an overdose of Sumatriptan?
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Which of the following is NOT a common treatment option for migraine?
Which of the following is NOT a common treatment option for migraine?
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What is the primary role of the pharmacist when supplying Sumatriptan OTC?
What is the primary role of the pharmacist when supplying Sumatriptan OTC?
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The presence of which type of receptor in triptans is primarily responsible for the constriction of cranial blood vessels?
The presence of which type of receptor in triptans is primarily responsible for the constriction of cranial blood vessels?
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Study Notes
Muscular Injuries
- Swelling, bruising, or severe pain could indicate a serious injury and referral is needed.
- A high-impact force injury could lead to a fracture.
- If the pain is sudden after a traumatic event, this could indicate a tendon or ligament tear.
- Inability to bear weight on the foot, ankle, or leg should be referred immediately.
- The range of motion and nature of pain should be assessed.
- Reffered pain could suggest nerve root compression.
- Pain that is insidious in onset and progressive is more likely to be a degenerative disease.
- Age plays a role, as children are susceptible to greenstick fractures, while the elderly are at risk for osteoporosis and osteoarthritis.
Treatment
- PRICE (Protect, Rest, Ice, Compression, Elevate)
- Simple analgesia (refer to part 1)
- Topical products (refer to part 1)
- Epsom salts or gel
- Arnica is often claimed to reduce bruising and inflammation, but studies show it has a small benefit similar to a placebo.
- unexplained bruising should be referred.
Back Pain
- Age is a key factor when considering referral.
- Under 15 years old: Higher incidence of potentially serious causes (refer unless sport related or due to schoolbag)
- 15-30 years: Prolapsed disc, trauma, fractures, pregnancy, ankylosing spondylitis are common causes
- 30-50 years: Osteoarthritis, prolapsed disc, malignancy
- Older than 50 years: Increased risk of osteoporosis, malignancy, metabolic bone disorders
- Location of pain, radiation, evidence of trauma, effect on mobility, factors that aggravate or relieve pain and the onset are all important to assess.
- Acute, sudden onset is mostly muscle strain (refer in the elderly), while insidious onset needs referral.
Treatment
- Simple analgesics ( refer if no improvement after 7-10 days)
- Topical products (NSAIDs, Rubefaciants)
- Hot and cold compress
- Bed rest may not be helpful
Period pain
- Common between menarche and menopause
- Affects over 50% of women with 7-15% having severe cases
- Caused by an overproduction of prostaglandin in the uterus
- Cramping pain shortly before bleeding lasting 2-3 days, associated with fatigue, back pain, nausea, vomiting, and diarrhea.
- Common in adolescents and young women.
- Pain is rarely severe, and it tends to decrease with the onset of menses.
- Pain often starts shortly before menses (6 hours) or within 24 hours of menses, rarely lasting more than 3 days.
Treatment
- NSAIDs: Very effective in 80-85% of women.
- Mefenamic acid is often prescribed on prescription.
- Hyoscine Butylbromide is an anti-spasmodic, but there is little evidence of its effectiveness over placebo.
- Paracetamol may not be very effective as it is not anti inflammatory.
Headache
- A headache is not enough information for accurate diagnosis and treatment, it is important to gather detailed information about the headache, such as when it occurs, the location, and the severity.
-
Important questions to ask
- Onset of headache?
- Frequency and timing?
- Location of pain?
- Severity of pain?
- Triggers?
- Attack duration?
- Associated symptoms?
Headache: Referral
- Headache in children under 12 with a stiff neck or rash
- Headache after recent trauma injury
- Nausea or vomiting in the absence of migraine symptoms
- Neurological symptoms
- New or severe headache in people over 50 years
- Progressive worsening of headache symptoms over time
- Very sudden and/or severe onset of headache
- Headaches unresponsive to simple analgesics
- Headache lasting more than 2 weeks
Tension Headache
- Symptoms:
- Bilateral
- Pain over the top of the head
- 'Band around the head'
- 'Weight pressing down'
- Non-pulsating
- Gradual onset, worsening over time
- four times as many women experience tension headaches compared to men.
- Triggers:
- Mental stress
- Physical stress
- Alcohol use
- Eye strain
- Caffeine
- Fatigue
- Excessive smoking
- Dental problems
Treatment
- Simple analgesics
- Heat
- Exercise or other de-stressors
- Headache diary
- Triggers
- Massage
- Biofeedback
- Acupuncture
- Cognitive behavioural feedback
- Adequate hydration
Migraine
- Symptoms:
- Unilateral
- Severe, throbbing
- Lasts 4 - 72 hours
- Nausea (almost all)
- Vomiting (1/3)
- Preceded by aura in 20% of cases (visual disturbances, nausea, vomiting, sensitivity to light, noise, movement)
- Triggers:
- Stress (environmental, hormonal, dietary, drugs, emotional, physical).
Migraine- Referral
- If the patient answers yes to two or more of the following questions, they could be experiencing migraines:
- Do you get headaches accompanied by nausea or vomiting?
- Is your headache severe or throbbing and usually on one side of your head (not always the same side)?
- Does bright light hurt your eyes during an attack?
- Do you become particularly sensitive to loud sounds and/or smells?
- Does you headache reduce your ability to work, study or socialise?
Migraine Treatment
- Simple analgesics (paracetamol, ibuprofen, Excedrin)
- Codeine-containing products (Nurofen Plus, Solpadeine, Migraleve)
- Sumatriptan (pharmacist consultation)
Sumatriptan
- Available as a pharmacy OTC since October 2018
- 50mg tablets
- Strict suitability criteria must be assessed by the pharmacist before supplying.
- Only for adults aged 18-65
- For acute treatment of migraine +/- aura, but not for prophylaxis
- Simple analgesics must have been tried and ineffective
- Must have a previous migraine diagnosis of more than 4 per month, or a first-ever migraine within the last 12 months.
- Must be able to understand and follow the advice given.
Sumatriptan Contraindications
- Pregnant / breastfeeding
- Taking medications mentioned in the contraindications
- Patients with a history of cardiovascular disease, including stroke.
- Women on COC (if migraine onset within the previous 3 months, are worsening or migraine with aura)
- Pattern of symptoms has changed, attacks are more frequent, persistent, or severe.
- Patients who are not fully recovered between attacks.
Sumatriptan Side Effects
- Dizziness, drowsiness, flushing, nausea, vomiting, heaviness, myalgia, pain, tightness, weakness
Medication Overuse Headache
- Prolonged use of any type of painkiller for headaches can make them worse.
- Medication overuse headaches occur 15 or more days per month as a consequence of regular use of headache medication for more than 3 months
- The regular use of simple analgesics (such as paracetamol, ibuprofen, aspirin), ergotamine, 5HT1 agonist medications, opioids, or combination analgesics can lead to medication overuse headache.
- Requires referral to a doctor.
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Description
Explore the key concepts of muscular injuries, including signs of serious conditions and common treatment methods. This quiz covers important aspects such as the purpose of PRICE, assessing pain, and the role of age in injury susceptibility. Test your knowledge on how to identify and manage muscular injuries effectively.
