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Chapter 54. Headache

A patient presents to your community pharmacy complaining of a headache. She rates the headache as a 7 on a scale of 1 to 10, and the pulsating worsens as the headache progresses. She experiences nausea and sensitivity to light until the headache dissipates after about 12 hours. She is unable to function during the headache. Which of the following headache types is this patient experiencing?

a. Migraine

b. Tension

c. Cluster

d. Caffeine

Answer a is correct. The International Headache Society diagnostic criteria for migraine includes:

Headache lasts for 4 to 72 hours and

At least two of the following characteristics:

Unilateral location, Pulsating, Moderate to severe intensity, Aggravated by routine physical activity

At least one of the following: Nausea and/or vomiting, Photophobia, and phonophobia.

Answer b is incorrect. Tension headache would have a gripping/tightening quality, not aggravated by activity, no nausea or vomiting, photophobia and phonophobia are absent or one but not the other is present.

Answer c is incorrect. Cluster headache would last for no longer than 180 minutes and exhibits signs/symptoms of conjunctival injection, lacrimation, nasal congestion, rhinorrhea, sweating miosis, ptosis, or eyelid edema.

Answer d is incorrect. Caffeine is a trigger for headaches, not a type of headache.

LK suffers from chronic migraines and is currently experiencing an acute attack. She calls your community pharmacy and asks your professional advice. In talking with her you learn that she stopped drinking regular coffee, joined a gym, and started a monophasic oral contraceptive in the past two weeks. She attended a wine and cheese party last night with friends she met at the gym. Which recommendation would be best to provide that may help prevent migraines in the future?

a. Avoid intake of wine and cheese.

b. She should resume drinking regular coffee.

c. She may benefit from switching to a triphasic oral contraceptive.

d. She should avoid physical activity.

Answer a is correct. Wine and cheese are tyramine containing foods which are known to be headache triggers. Other potential food triggers include alcohol, chocolate, citrus fruits, dairy, fermented foods, and foods containing additives such as monosodium glutamate, nitrites, saccharin, sulfites, or yeast. When trying to determine a trigger of a patient’s headache, it is recommended that the patient eliminate all causative agents and then gradually add back in one item at a time.

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