Migraine Flashcards
What is a migraine?
A recurrent headache that occurs with or without aura
How long can a migraine last?
30 minutes to 48 hours
How common are migraines compared to other causes of primary headaches in adults?
The most common
Are migraines the same in children as in adults?
No
What does migraines being different in adults lead to?
Under-diagnosis in children
What are the risk factors for migraine?
Male (pre-menarche)
Female (post-menarche)
How can the presentation of a migraine in children differ to adults?
More prominent non-headache and neurological symptoms
What is a diagnosis of migraine based on?
History and examination
What are important parts of an examination when assessing headaches in children?
Fundoscopy and head circumference
Are further investigations normally required?
No
When may further investigations be required?
- Abnormal neurological examination
- Papilloedema
- History of seizures
- History of head trauma
- Significant unexplained change in pattern of headaches
What are the differentials for migraine?
- Other causes of headache
- Other causes of aura
What are the three types of management for migraines?
- Conservative measures
- Drug intervention for acute attacks
- Drug intervention for prophylaxis
What conservative management steps should be tried?
- Explanation and reassurance
- Identification of triggers and predisposing factors
- Behavioural management strategies
What may act as a trigger or predisposing factor for migraine onset?
- Sleep (lack of)
- Stress
- Dehydration
- Video games
What are the aims of behavioural management strategies?
Emphasise routines for sleeping and eating and strategies for dealing with an attack
When should drug interventions be considered for acute attacks?
When conservative methods have failed or attacks are severe
What are recommended as first line?
Simple analgesics
What can be given as second line in acute migraine management?
Sumatriptan or zolmitriptain
What types of drugs are sumatriptan or zolmitriptain
5HT-1 receptor antagonists
What drugs can be given if nausea is a problem?
Anti-emetics
What anti-emetic is suitable for children of all ages?
Domperidone
What anti-emetic is suitable for children over 12 only?
Prochlorperazine
When should prophylactic drug intervention be considered?
When frequency and severity interferes with school attendance
Can prophylaxis be used without acute therapy?
No
What drugs can be used in the prophylaxis of migraines?
Propranolol, topiramate or pizotifen
