Migraine

Question 1

What is usually involved in the visual aspect of an aura of a migraine?

Answer 1

Shimmering zig-zags, flashing lights/spots, temporary vision loss.

Question 2

What is usually involved in the somatosensory and motor aspects of an aura of a migraine?

Answer 2

1. Somatosensory - paraesthesia

2. Motor - ataxia, dysarthria

Question 3

What is usually involved in the speech aspect of an aura of a migraine?

Answer 3

Dysphasia

Question 4

What are the risk factors for migraines?

Answer 4

Female, premenstrual, COCP, obesity

Question 5

What is the criteria for migraine diagnosis without aura?

Answer 5

5 or more headaches lasting 4-72 hours + nausea/vomiting or photophobia/phonophobia + any two of: unilateral/pulsating/impairs routine activity.

Question 6

What is the criteria for migraine diagnosis with aura?

Answer 6

2 or more headaches with aura

Question 7

What is the lifestyle management for migraines?

Answer 7

Avoid identified triggers, regular meals, good sleep, avoid dehydration.

Question 8

What is the prophylaxis treatment for migraines?

Answer 8

1. Propranolol (usually)
2. Topiramate (teratogenic, good if overnight)
3. Amitriptyline (good for mood issues)
4. Candesartan
5. Magnesium supplements BD help

Question 9

What is the treatment during a migraine?

Answer 9

1. Oral triptan with NSAID and high dose aspirin.
2. Anti-emetic - domperidone/metoclopramide
3. Warm/cold packs on head, rebreathing into paper bag (increase PaCO2)

Question 10

What are the contraindications for triptans?

Answer 10

IHD, uncontrolled HTN, lithium, SSRIs (vasoconstrictors)

Question 11

Why are females with a migraine aura not for COCP and what alternative is used?

Answer 11

1. Increased risk of ischaemic stroke

2. Try progesterone only