Migraine Flashcards
When does migraines usually present?
early to midlife
How serious are migraines?
- Chronic episodic
- Severe effect on quality of life
- Some menstrual migraine
How common are migraines?
- 6th most common disease worldwide
- second most disabling disease
- More common in women post puberty
What are RF for migraine?
- FHx of migraine
- Female sex
- Obesity
- Stressful life events
- Medication overuse
- Sleep disorders
What acronym is used to remember partial triggers for migraines?
CHOCOLATE
What does CHOCOLATE stand for?
chocolate hangovers orgasms cheese/caffiene oral contraceptives lie-ins alcohol travel exercise
What are common symptoms and signs of migraine?
- Prolonged headache: 4-72hr
- Visual disturbance
- Nausea
- Vomiting
- Photophobia or phonophobia
- Headache worse with activity
How long is an aura?
15-30 mins then unilateral throbbing headache
Can you have migraines without aura?
episodic severe headaches without aura, often premenstrual unilateral with nausea vomiting
What are different parts of an aura?
- visual chaotic disorting
- Somatosensory
- Motor
- speech
What is prodrome?
recedes headache by hours to days: yawning, craving, mood/sleep change
What are possible DDx for migraine?
- Tension headaches
- Cluster headache
- Medication overuse headache
- SAH
- Headache after head or neck trauma
Etc
What investigations are used for migraine?
clinical diagnosis
What is the diagnostic criteria for migraines?
if no aura: >5 headaches lasting 4-72hrs with nausea/vomiting or photophobia and any two of unilateral, pulsating, impairs or worsened by routine activity
What is treatment for acute bad migraine?
1st line: rescue therapy e.g. metoclopramide 10-20mg IV
- hydration
- High-flow oxygen
- IV corticosteroid
What is the treatment for mild to moderate migraines (not preggers)?
1st line: NSAIDs
Anti-emetic
2nd line: paracetamol monotherapy
3rd line: aspirin
What is the treatment for severe migraine?
1st line: triptan e.g. almotriptam 6.25mg to 12.5mg orally with paracetamol or NSAIDs and can use anti-emetic
What anti-emetic should not be used regularly?
metoclopramide regularly as extrapyramidal side effects
What is ongoing treatment for migraine?
trigger avoidance and non-pharm therapies
What are possible preventative drugs for migraine?
- Topiramate
- Amitriptyline
- Magnesium
- Triptan
- Anticonvulsant – NOT gabapentin
- Beta-blocker: e.g. propananol
- Tricyclic antidepressant
- CCB
- Antidepressant
- Calcitonin gene-related peptide antagonist
- Botulin toxin A
How would you treat pre-menstrual migraine?
if uncontrolled and predictable onset – frovatriptam or zolmitriptan
What are possible complications of migraine?
- Complications of pregnancy
- Status migrainosus (more than 72hr)
- Migrainous infarction
- Migraine-triggered seizure
- Depression
Why can you not prescribe opiods with migraine?
are pro-nociceptive, prevent reversal of migraine central sensitization, and interfere with triptan effectiveness
What is conservative management for migraines?
- Headache diary
- Avoid triggers
- Relaxation techniques (CBT, mindfulness)
What is the acute treatment for migraine?
1) Simple analgesia (paracetamol, Ibuprofen)
2) Triptans – specific to migraines
What is the preventative management for migraine?
1) Propanolol or topimarate
2) Amitryptiline
