Migraine (1)

Question 1

How does it present?

There tends to be an identifiable trigger. What are some examples of these?

Answer 1

➊ • Unilateral throbbing headache preceded by an aura, such as visual (e.g. lines, zigzags) or sensory (paraesthesia spreading from fingers to face)
‣ Headache may last up to 72 hrs
• Photophobia
• Phonophobia
• N+V

➋ Stress, bright lights, strong smells, certain foods, dehydration, contraceptive pill, menstruation

Question 2

How is it diagnosed?

Answer 2

• Clinical – History is key
• Presence of aura helps confirm the diagnosis
• In headaches w/o aura:
‣ 5+ headaches lasting up to 72 hrs, with N+V or photo/phonophobia AND 2 of unilateral headache, pulsating character, impaired or worsened by daily activities

Question 3

Management:
How is it managed acutely?

How is it managed prophylactically?
→ In who should these medications be avoided in?

Answer 3

➊ Sumatriptan +/- NSAID/Paracetamol

N.B. Sumatriptan is a contraindication in those with IHD/Previous stroke as it constricts the cerebral blood vessels.

➋ * Headache diary to identify and avoid triggers
* Propranolol, Topiramate or Amitriptyline
→ * Propranolol should be avoided in asthmatics
* Topiramate is teratogenic, so avoid in pregnant women

N.B. The COCP is a contraindication here as it increases the risk of ischaemic stroke