migraine+stress+and+OCP

=Migraine (Stress and OCP)=

//A 30yr old woman walks into your pharmacy, requesting something for her headache.//

Problem
Being able to determine the type of headache, which will help select the correct therapy. = =

Questions to Ask
- How long have you had the headache for? //A few days// - Can you describe the pain? //quite severe, and throbbing// - Where is the pain located? //on one side of my head// - Do you experience any symptoms before the pain? (visual disturbances, 'pins and needles') //no// - Any other symptoms? (nausea/vomiting, sensitive to light or noise) //nausea//

- Is there anything that may have triggered the headache? (new medications, stress) //I have recently started the oral contraceptive pill. I also work in an executive office position (very stressful)// - Have you taken anything for your headache so far? //I tried some panadol, but it didn't work (took two tablets up to the maximum 8 tablets per day). My friend suggested some Panadeine 15s (paracetamol + codeine).//

What to do
- signs point to migraine - possibly triggered by OCP or stress from job - suggest soluble aspirin or rapid-acting paracetamol. Combination metoclopramide + paracetamol would be effective for the nausea - refer to the doctor for migraine-specific medication (ergotamine, triptan) - non-pharmacological therapy: cold compress on head, avoid triggers (light and noise) - rest in a dark, quiet room - suggest a trigger diary (write down circumstances when migraine occurs) - would not suggest Panadeine as the codeine can make the nausea worse (plus minimal additive affect for the pain relief)