Cough & Headache Lecture PDF

Cough & Headache Dr. Sara Youssif PhD, BCPS  At the end of this lecture, you will be able to: Know what is cough & headaches. Define what common cause of cough & headaches. Know classification of cough & headache. Define how to manage cough & headache. Define Trigger points...

Cough & Headache Dr. Sara Youssif PhD, BCPS  At the end of this lecture, you will be able to: Know what is cough & headaches. Define what common cause of cough & headaches. Know classification of cough & headache. Define how to manage cough & headache. Define Trigger points Indicative for referral.  Cough  Coughing is a protective reflex action caused when the airway is being irritated or obstructed.  Its purpose is to clear the airway so that breathing can continue normally.  The majority of coughs presenting in the pharmacy will be caused by a viral upper respiratory tract infection.  They will often be associated with other symptoms of a cold.  Most common causes of cough Inflammation Mechanical Bronchitis, Laryngitis, Alveolar inflammation Compression of air - Pneumonia. passage (external – internal). Other causes Chemical GERD, ACE inhibitor, air Inhalation of irritant gases pollution. – chemical, fumes, - cigarette smoking  Types of cough Types of cough: Non-productive (dry cough) (no sputum). Productive cough. Coughs are either classified as acute or chronic in nature: An acute cough lasts less than 3 weeks. Chronic cough lasts more than 8 weeks. Any cough lasting longer than 3 weeks should be referred to a medical practitioner for further investigation. What you need to know Age ( Baby, child, adult) Duration Nature Dry or productive Associated symptoms: 1) Cold, sore throat, fever 2) Chest pain 3) Shortness of breath 4) Wheeze What you need to know  Previous history: 1) COPD (chronic obstructive airways disease) 2) Asthma 3) Diabetes 4) Heart disease 5) Gastro-esophageal reflux disorder (GERD) 6) Smoking habit 7) Present medication  Causes of cough and their relative incidence in community pharmacy Incidence Cause Most Likely Viral infection Likely Upper airways cough syndrome (formerly known as postnasal drip and includes allergies), acute bronchitis Unlikely Croup, chronic bronchitis, asthma, pneumonia, ACE inhibitor induced Very unlikely Heart failure, tuberculosis, cancer, pneumothorax Pneumothorax  Trigger points Indicative for referral Possible danger/reason for Symptoms/signs referral Chest pain, Haemoptysis All are symptoms outside remit of Pain on inspiration , Wheeze and/or community pharmacist. shortness of breath Duration longer than 3 weeks. Suggests non-acute cause of Cough that recurs on a regular basis. cough and requires further investigation. Debilitating symptoms This patient group at greater in the elderly risk of complications Persistent nocturnal cough in children Suggests possible asthma  Treatment timescale Depending on the length of time the patient has had the cough and once the pharmacist has recommended an appropriate treatment. Patients should see their doctors 3 weeks after the cough started if it hasn’t improved.  1- Antitussives (cough suppressant) Indication: nonproductive cough (reduce the frequency or intensity of cough) M.O.A: Work centrally in medulla to increase the cough threshold 1.Codeine, Dihydrocodeine, Pholcodine (Narcotic): Opioid analgesic with antitussive effects at doses lower than those required for analgesia. - AE: constipation, dysphoria & fatigue, addictive potentiality. 2.Dextromethorphan (Non-narcotic): synthetic derivative of morphine (Tussilar): As compared to codeine:  - No analgesia- Low addictive profile- Better AE & equally active  Dextromethorphan (inhibits serotonin reuptake) is contraindicated to be taken with MAOIs.  1- Antitussives (cough suppressant)  Topical antitussive: Menthol & Camphor: produce cooling and local anesthetic effects.  Available as Ointment (rubbed into throat & chest). lozenges (Mento pastilles). Steam inhaler (in steam vaporizer).  2- Mucolytic & Expectorants Indication: productive cough A- Mucolytic M.O.A: loosen thick bronchial secretions by breaking down the chemical structure of mucus molecules. Mucus becomes thinner and can be removed more easily through coughing. 1.Acetylcysteine (sachets): AE: bronchospasm, GI irritation & high liability for drug- drug interactions. 2.Carbocysteine (Mucosol) Adverse effect over acetylcysteine : no bronchospasm so safer in asthmatic patients + decrease mucus gland hyperplasia so more effective in chronic conditions.  2- Mucolytic & Expectorants B-Expectorants: M.O.A: stimulate respiratory secretion leads to increase volume of respiratory fluids so thin mucus become easier to be expelled. e.g. guaifenesin (in Octovent plus) AE: Nausea, vomiting & diarrhea  Headaches A headache occurs when any of the pain-sensitive structures in the head and neck are stimulated. These include the meninges, blood vessels, nerves, and muscles.  Types of headache Headaches can be classified into two types: 1) Primary headaches, and they’re more common. These are chronic or recurrent headaches and include tension headaches, migraines, and cluster headaches. 2) Secondary headaches, and these are acute headaches from a specific underlying cause like a serious head injury, infection, or a brain tumor.  A. Primary headaches 1- Tension headache Tension headaches are the most common type and they’re more common in females. The classic description is a headache that is slowly-progressive, bilateral, tight, “band-like” headache with no other associated symptoms. Typically, they lasts from 30 minutes to up to a week, and is usually triggered by stress and dehydration.  1- Tension headache Treatment: Non-steroidal anti-inflammatory drugs (NSAIDs) Chronic pain can be treated with amitriptyline or other tricyclic antidepressants.  2- Migraine headache Migraine headache is another primary headache and it’s also more common in females. They usually have triggers, such as specific foods, weather, bright lights, loud noises, physical exertion, or lack of sleep. Migraine headaches usually last between 4 to 72 hours, and it’s usually a severe, unilateral, pulsating or throbbing pain that’s aggravated by movement. Also, individuals can have nausea or vomiting. Often, they isolate themselves in a dark room to avoid light and sound, and this is called photophobia and phonophobia.  2- Migraine headache It can cause an aura before or during the headache, which consists of visual symptoms like seeing bright lights, zigzag lines. Or other neurological symptoms like tinnitus, aphasia, or confusion. Sometimes, the aura can present as a temporary paralysis of one side of the body, in which case the attack would be called a hemiplegic migraine, and can be confused with a stroke. The difference is strokes don’t usually cause severe headaches.  2- Migraine headache Treatment: NSAIDs and other analgesics can be used. Sumatriptan is used to treat more severe migraines. For prevention: lifestyle changes can make a difference, but beta-blockers like propranolol, or amitriptyline can also help.  3- Cluster headache Cluster headaches are the rarest form of primary headache and usually occur in males. They are classically described as an excruciating, stabbing pain located unilaterally behind the eye. They usually occur every day for about 8 to 10 weeks per year, and not the rest of the year. They also occur at almost the same time every day, and last anywhere between 15 minutes to 3 hours. Cluster headaches have been linked with cigarettes and alcohol.  3- Cluster headache Individuals with cluster headaches pace around, because there’s nothing that really provides comfort. They’re usually associated with autonomic symptoms on the affected side, such as ptosis, miosis, lacrimation, and nasal congestion.  3- Cluster headache Treatment: 100% oxygen and Sumatriptan are used. For prophylaxis: Verapamil, valproic acid, or lithium are effective.  B. Secondary headaches (e.g. subarachnoid hemorrhage, meningitis, sinusitis, brain abscess & brain tumor) B. Secondary headaches B. Secondary headaches B. Secondary headaches  Caffeine withdrawal can also cause a mild headache approximately 12 to 24 hours after the last cup of coffee. Quick recap