MIgraine

Question 1

What is a migraine?

Answer 1

Migraines are a complex neurological condition that cause headache and other associated symptoms. They occur in “attacks” that often follow a typical pattern.

Question 2

What are the different types of migraines?

Answer 2

Migraine without aura
Migraine with aura
Silent migraine (migraine with aura but without a headache)
Hemiplegic migraine

Question 3

What are the typical headache symptoms in a migraine

Answer 3

Headaches last between 4 and 72 hours. Typical features are:

Moderate to severe intensity
Pounding or throbbing in nature
Usually unilateral but can be bilateral
Photophobia
Phonophobia
With or without aura
Nausea and vomiting

Question 4

What is aura?

Answer 4

Aura is the term used to describe the visual changes associated with migraines. There can be multiple different types of aura:

Sparks in vision
Blurring vision
Lines across vision
Loss of different visual fields

Question 5

What is a hemiplegic migraine?

Answer 5

Hemiplegic migraines can mimic stroke. It is essential to act fast and exclude stroke.

Symptoms of a hemiplegic migraine can vary significantly. They can include:
Typical migraine symptoms
Sudden or gradual onset
Hemiplegia (unilateral weakness of the limbs)
Ataxia
Changes in consciousness

Question 6

What are the triggers for migraines

Answer 6

CHOCOLATE

• chocolate
• hangovers
• orgasms
• cheese/ caffeine
• oral contraceptives
• lie-ins
• alcohol
• travel
• exercise

Question 7

What are the five stages of a migraine?

Answer 7

1. Premonitory or prodromal stage (can begin 3 days before the headache)
2. Aura (lasting up to 60 minutes)
3. Headache stage (lasts 4-72 hours)
4. Resolution stage (the headache can fade away or be relieved completely by vomiting or sleeping)
5. Postdromal or recovery phase

Question 8

What is the acute management of migraines

Answer 8

Paracetamol
Triptans (e.g. sumatriptan 50mg as the migraine starts)
NSAIDs (e.g ibuprofen or naproxen)
Antiemetics if vomiting occurs (e.g. metoclopramide)

Question 9

What are Triptans

Answer 9

Triptans are used to abort migraines when they start to develop. They are 5HT receptors agonists (serotonin receptor agonists).

Question 10

Mechanism of triptans

Answer 10

Triptans cause:
Smooth muscle in arteries to cause vasoconstriction
Peripheral pain receptors to inhibit activation of pain receptors
Reduce neuronal activity in the central nervous system

Question 11

What medication can be used long term to reduce the frequency and severity of attacks

Answer 11

• Propranolol
• Topiramate (this is teratogenic and can cause a cleft lip/palate so patients should not get pregnant)
• Amitriptyline

Question 12

If migraine is triggered around menstruation what drug is used for prophylaxis?

Answer 12

NSAIDs (e.g. mefanamic acid)

Triptans (frovatriptan or zolmitriptan)

Question 13

Other migraine prophylaxis

Answer 13

Acupuncture

Supplementation with vitamin B2 (riboflavin)