Muscular Injuries and Treatment Overview
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Muscular Injuries and Treatment Overview

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Questions and Answers

Which group of individuals is at increased risk of complications if they experience migraines?

  • Men aged 40 and over with risk factors (correct)
  • Women in their reproductive years without migraines
  • Individuals with a family history of common colds
  • Active athletes under 30 years old

    • What is considered a criteria for diagnosing medication overuse headache?

  • Headaches experienced solely during exercise
  • Headaches occurring on less than 10 days a month
  • Use of analgesics for less than three months
  • Regular use of headache medication for more than three months (correct)

    • Which condition cannot be treated with sumatriptan according to the guidelines?

  • Chest pain thought to indicate ischaemic heart disease (correct)
  • First-time migraine experienced within the last year
  • Migraine attacks that are mild and infrequent
  • Migraine occurring less than 10 days a month

    • What symptom indicates a change requiring medical evaluation for patients with a history of migraines?

    <p>Increased severity and frequency of attacks</p> Signup and view all the answers

    Which scenario represents a significant contraindication for combined oral contraceptive use in women suffering from migraines?

    <p>Migraine onset less than three months ago with aura</p> Signup and view all the answers

    Which factor is least likely to require referral for a muscular injury?

    <p>Bruising with minimal pain</p> Signup and view all the answers

    Which type of pain is predominantly associated with nerve root compression?

    <p>Muscular pain from a soft-tissue injury</p> Signup and view all the answers

    In which patient demographic is the risk of osteoporosis primarily increased?

    <p>Patients older than 50 years</p> Signup and view all the answers

    What is a recommended treatment approach for acute soft-tissue injury?

    <p>PRICE method</p> Signup and view all the answers

    What is the most common misconception regarding the use of arnica for bruising?

    <p>Arnica has a clinically significant effect on bruising.</p> Signup and view all the answers

    What symptom predominantly indicates a possible serious back pain condition in patients under 15 years?

    <p>Severe and persistent pain</p> Signup and view all the answers

    Which of the following is NOT a consideration for diagnosing back pain?

    <p>Color of the skin over the affected area</p> Signup and view all the answers

    Which of these is NOT a key component of the WWHAM questioning method?

    <p>Home environment</p> Signup and view all the answers

    What is the primary treatment option recommended for tension headaches?

    <p>Simple analgesics</p> Signup and view all the answers

    Which symptom would indicate the need for immediate referral regarding a headache?

    <p>Severe headache following a fall two weeks ago</p> Signup and view all the answers

    What symptom would most likely require referral for back pain management?

    <p>Numbness persisting for more than two days</p> Signup and view all the answers

    Which of the following is NOT considered effective treatment for primary dysmenorrhoea?

    <p>High-dose glucosamine</p> Signup and view all the answers

    What is a common trigger for tension headaches?

    <p>Mental stress</p> Signup and view all the answers

    In which situation should a referral for primary dysmenorrhoea definitely be considered?

    <p>Cramping pain that occurs before the onset of menstruation</p> Signup and view all the answers

    What characteristic is NOT typically associated with migraine headaches?

    <p>Gradual onset accompanied by tension</p> Signup and view all the answers

    Which vitamin is mentioned as a possible aid for headache relief?

    <p>Vitamin E</p> Signup and view all the answers

    What clinical feature is often associated with the onset of primary dysmenorrhoea symptoms?

    <p>Cramping pain beginning shortly before menstrual bleeding</p> Signup and view all the answers

    Which factor would not typically indicate the need for referral in chronic back pain cases?

    <p>Pain present only during physical activity</p> Signup and view all the answers

    What duration of headache requires consideration for referral?

    <p>Over two weeks</p> Signup and view all the answers

    What symptom is typical of a tension headache?

    <p>A band-like sensation</p> Signup and view all the answers

    What is a common characteristic of primary dysmenorrhoea?

    <p>Symptoms typically resolving after 3 days</p> Signup and view all the answers

    Which of the following is least likely to improve symptoms of acute back pain?

    <p>Sustained bed rest for several days</p> Signup and view all the answers

    For migraines, which symptom is most commonly reported?

    <p>Visual disturbances during an aura</p> Signup and view all the answers

    What shared feature is found in both sciatica management and primary dysmenorrhoea treatment?

    <p>Assessment of symptom severity and onset</p> Signup and view all the answers

    Which of the following is NOT a recommended treatment for tension headaches?

    <p>High-dose corticosteroids</p> Signup and view all the answers

    Which symptom can be indicative of a condition that warrants immediate referral in sciatica cases?

    <p>Signs of systemic infection such as fever</p> Signup and view all the answers

    What is typically NOT a recognized trigger for migraines?

    <p>Haircut stress</p> Signup and view all the answers

    What is a common misconception regarding primary dysmenorrhoea symptoms?

    <p>They affect all women uniformly</p> Signup and view all the answers

    Which symptom is NOT typically associated with a migraine?

    <p>Stiff neck</p> Signup and view all the answers

    What is the maximum dosage of Sumatriptan within a 24-hour period for an adult?

    <p>100 mg</p> Signup and view all the answers

    What is the primary mechanism of action of triptans like Sumatriptan?

    <p>Stimulation of 5HT1B and 5HT1D receptors</p> Signup and view all the answers

    Which of the following is NOT a content of the pink tablet of Migraleve®?

    <p>Aspirin</p> Signup and view all the answers

    What is the purpose of assessing cardiovascular risk before supplying Sumatriptan OTC?

    <p>To assess risk of cardiovascular events or ischaemic heart disease</p> Signup and view all the answers

    Which side effect is commonly associated with Sumatriptan?

    <p>Dizziness</p> Signup and view all the answers

    What symptoms might indicate an overdose of Sumatriptan?

    <p>Combination of dizziness, flushing, and nausea</p> Signup and view all the answers

    Which of the following is NOT a common treatment option for migraine?

    <p>Migraine relief teas</p> Signup and view all the answers

    What is the primary role of the pharmacist when supplying Sumatriptan OTC?

    <p>Evaluate suitability based on strict criteria</p> Signup and view all the answers

    The presence of which type of receptor in triptans is primarily responsible for the constriction of cranial blood vessels?

    <p>5HT1B</p> Signup and view all the answers

    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.

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