Migraine Flashcards
what are the characteristic features of a migraine
how does it present
severe unilateral throbbing headache
nausea
photophobia
phonophobia
can last between 4-72hrs
classically preceded by aura (occur in 1/3 of patients)
has identifiable triggers e.g. coffee, chocolate, dehydration, stress
patients go to a darkeneded, quiet room during an attack
they are disabling and you can’t continue with normal activities
what is aura
how long does it last
what is most common type
aura is a disturbance which can happens about 1hr before migraine (severe unilateral throbbing headache) occurs
but headache is does not always occur after aura
progressive –> develops over 5mins
last 5-60mins
**are fully reversible **
most common is visual –> transient hemianopic disturbance or scintillating scotoma (blin spot)
other types include sensory e.g. parathesia, verbal e.g speech arrest
epidemiology of migraines
3x more common in women than men
what are common triggers for a migraine attack
key feature of migraines is them having identifable triggers:
tiredness, stress
alcohol
combined oral contraceptive pill
lack of food or dehydration
cheese, chocolate, red wines, citrus fruits
menstruation
bright lights
management involves avoiding individual’s triggers
what is the diagnostic criteria for migraines
how do migraines present in children
shorter duration
gastrointestinal upset
bilateral headache
how are migraines diagnosed
clinical diagnosis - based on symptoms (as long as they are typical + not recently worsening)
presence of aura makes it much easier to diagnose
aware of red flag features + atpical symptoms which would need further investigation
what are atpical migraine features
motor weakness
double vision
visual symptoms affecting only one eye
poor balance
decreased level of consciousness.
these symptoms warrant further investigations
how are migraines treated
trigger avoidance
prophylaxis (if >2 attacks per month):
propanolol (not in asthma) or topiramate (highly teratogenic) or amirtriptyline
**relief during acute attacks: **
NSAIDs + paracetamol
Triptans (not in pregnancy or angina)
