Migraine

Question 1

Definition of Migraine

Answer 1

A headache of varying intensity, often accompanied by nausea and sensitivity to light and sound.

Migraine headaches are sometimes preceded by warning symptoms. Triggers include hormonal changes, certain food and drink, stress and exercise.

Question 2

Aetiology/ Causes/ Risk factors

Answer 2

Aetiology

Stress at work or home can cause migraines. Sensory stimuli. Bright or flashing lights can induce migraines, as can loud sounds. Strong smells — such as perfume, paint thinner, secondhand smoke and others — trigger migraines in some people

There are a number of migraine triggers, including:

Hormonal changes in women. Fluctuations in estrogen, such as before or during menstrual periods, pregnancy and menopause, seem to trigger headaches in many women.

Hormonal medications, such as oral contraceptives, also can worsen migraines. Some women, however, find that their migraines occur less often when taking these medications.

Drinks. These include alcohol, especially wine, and too much caffeine, such as coffee.
Stress. Stress at work or home can cause migraines.
Sensory stimuli. Bright or flashing lights can induce migraines, as can loud sounds. Strong smells — such as perfume, paint thinner, secondhand smoke and others — trigger migraines in some people.
Sleep changes. Missing sleep or getting too much sleep can trigger migraines in some people.
Physical factors. Intense physical exertion, including sexual activity, might provoke migraines.
Weather changes. A change of weather or barometric pressure can prompt a migraine.
Medications. Oral contraceptives and vasodilators, such as nitroglycerin, can aggravate migraines.
Foods. Aged cheeses and salty and processed foods might trigger migraines. So might skipping meals.
Food additives. These include the sweetener aspartame and the preservative monosodium glutamate (MSG), found in many foods.

Risk factors
Several factors make you more prone to having migraines, including:

Family history. If you have a family member with migraines, then you have a good chance of developing them too.
Age. Migraines can begin at any age, though the first often occurs during adolescence. Migraines tend to peak during your 30s, and gradually become less severe and less frequent in the following decades.
Sex. Women are three times more likely than men to have migraines.
Hormonal changes. For women who have migraines, headaches might begin just before or shortly after onset of menstruation. They might also change during pregnancy or menopause. Migraines generally improve after menopause.

Question 3

Signs and symptoms

Answer 3

Pain areas: in the face or neck
Pain types: can be dull
Headache: can be acute, frequent, or throbbing
Visual: sensitivity to light, distorted vision, or seeing flashes of light
Whole body: dizziness, light-headedness, or malaise
Sensory: aura or sensitivity to sound
Gastrointestinal: nausea or vomiting
Also common: irritability, nasal congestion, or scalp tenderness

Migraine headaches can cause throbbing in one particular area that can vary in intensity. Nausea and sensitivity to light and sound are also common symptoms.

Question 4

Investigations

Answer 4

There’s no specific test to diagnose migraines. For an accurate diagnosis to be made, a GP must identify a pattern of recurring headaches along with the associated symptoms. Migraines can be unpredictable, sometimes occurring without the other symptoms. Obtaining an accurate diagnosis can sometimes take time.

Question 5

Complications

Question 6

Alternative/Differential diagnosis

Question 7

Management/Treatment