[31] Migraine Flashcards

1
Q

What is a migraine?

A

A recurrent headache that occurs with or without aura

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2
Q

How long can a migraine last?

A

30 minutes to 48 hours

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3
Q

How common are migraines compared to other causes of primary headaches in adults?

A

The most common

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4
Q

Are migraines the same in children as in adults?

A

No

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5
Q

What does migraines being different in adults lead to?

A

Under-diagnosis in children

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6
Q

What are the risk factors for migraine?

A

Male (pre-menarche)

Female (post-menarche)

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7
Q

How can the presentation of a migraine in children differ to adults?

A

More prominent non-headache and neurological symptoms

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8
Q

What is a diagnosis of migraine based on?

A

History and examination

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9
Q

What are important parts of an examination when assessing headaches in children?

A

Fundoscopy and head circumference

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10
Q

Are further investigations normally required?

A

No

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11
Q

When may further investigations be required?

A
  • Abnormal neurological examination
  • Papilloedema
  • History of seizures
  • History of head trauma
  • Significant unexplained change in pattern of headaches
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12
Q

What are the differentials for migraine?

A
  • Other causes of headache

- Other causes of aura

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13
Q

What are the three types of management for migraines?

A
  • Conservative measures
  • Drug intervention for acute attacks
  • Drug intervention for prophylaxis
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14
Q

What conservative management steps should be tried?

A
  • Explanation and reassurance
  • Identification of triggers and predisposing factors
  • Behavioural management strategies
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15
Q

What may act as a trigger or predisposing factor for migraine onset?

A
  • Sleep (lack of)
  • Stress
  • Dehydration
  • Video games
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16
Q

What are the aims of behavioural management strategies?

A

Emphasise routines for sleeping and eating and strategies for dealing with an attack

17
Q

When should drug interventions be considered for acute attacks?

A

When conservative methods have failed or attacks are severe

18
Q

What are recommended as first line?

A

Simple analgesics

19
Q

What can be given as second line in acute migraine management?

A

Sumatriptan or zolmitriptain

20
Q

What types of drugs are sumatriptan or zolmitriptain

A

5HT-1 receptor antagonists

21
Q

What drugs can be given if nausea is a problem?

A

Anti-emetics

22
Q

What anti-emetic is suitable for children of all ages?

A

Domperidone

23
Q

What anti-emetic is suitable for children over 12 only?

A

Prochlorperazine

24
Q

When should prophylactic drug intervention be considered?

A

When frequency and severity interferes with school attendance

25
Q

Can prophylaxis be used without acute therapy?

A

No

26
Q

What drugs can be used in the prophylaxis of migraines?

A

Propranolol, topiramate or pizotifen