Migraine

Question 1

What is this a presentation of?
Severe, bilateral or frontal headache lasting 1-48 hours with nausea/vomiting and any 2 of: photophobia, phonophobia, vertigo, abdominal pain, visual or sensory aura.

Answer 1

Migraine

Question 2

What are the triggers for a migraine?

Answer 2

Dehydration, poor sleep, diet, stress.

Question 3

What is the management for a migraine in children?

Answer 3

1. Paracetamol/ibuprofen as soon as attack starts.
2. Domperidone for nausea
3. If >12 years, try sumatriptan.
4. Consider prophylaxis if disturbing schooling/social life - pizotifen 1st line, propranolol 2nd line.

Question 4

When should you refer a migraine to neurology?

Answer 4

1. Increasing frequency
2. <6 years of age
3. Unrelieved by paracetamol/ibuprofen
4. Irritable, loss of interest/skills, slowing of development.
5. Head circumference >97th percentile.

Question 5

What are the general headache red flags?

Answer 5

1. Early morning headache
2. Nausea and vomiting
3. Visual changes
4. Abnormal neurological examination
5. Fever, photophobia, neck stiffness.