Migraine Flashcards
What is a migraine?
Primary headache characterised by recurrent episodes of unilateral, localized pain a/w systemic disturbance.
How can migraine be subclassified?
With aura (classic ~1/3)
Without aura (common migraine)
Migraine variants (familial hemiplegic, opthalmoplegic + basilar).
Describe the epidemiology of migraine
F > M 3:1
Usual onset in adolescence/ early adulthood, but can occur in middle age.
List 5 triggers/ risk factors for migraine
Tiredness, stress
Alcohol
COCP
Fasting / dehydration
Foods (e.g. caffeine, cheese, chocolate)
Menstruation
Bright lights
Describe the headache in migraine
Severe
Pulsatile/ Throbbing
Unilateral
Duration 4-72h
What occurs in aura precipitating migraines?
Typically visual, progressive
Last 5-60 mins
Characterised by transient hemianopic disturbance or a spreading scintillating scotoma
Flashing lights, Spots, Blurring, Zigzag lines, Blind spots
List 3 symptoms of migraine
N+V
Photophobia
Phonophobia
List signs of migraine
NO specific physical findings
What mneumonic describes the headache in migraines?
POUND
Pulsatile
One-day duration
Unilateral
N+V
Disabling intensity
Describe diagnosis of migraine
Clinical dx
R/O red flag causes of headache
Describe criteria for diagnosis of migraine without aura
> ,5 attacks
4-72h duration
Headache that is >,2 of: unilateral, pulsating, mod-severe pain, worsened by activity
Concomitant Sx: N+V, Photophobia, Photophobia
Describe criteria for migraine with aura
> ,2 attacks
,1 of visual, sensory, speech, motor, brainstem, retinal Sx of aura
≥ 3 characteristics of aura
Describe investigations for migraine to rule out differential diagnoses
Neuro exam
Fundoscopy: r/o raised ICP
ESR: r/o temporal arteritis
CT/ MRI: r/o SOL, SAH
LP: r/o SAH, meningitis, low/ high CSF pressure
Describe acute management of migraine
Combination therapy:
Oral Triptan (5-HT agonist) + NSAID
OR
Oral Triptan + Paracetamol
If ineffective: non-oral metoclopramide or prochlorperazine + non-oral triptan/ NSAID
What is prescribed in preference to oral triptans in 12-17 year olds?
Nasal triptans
When is migraine prophylaxis indicated?
If attacks are having significant impact on QoL + daily function, e.g. occur frequently (> once a week on average) or are prolonged + severe despite optimal acute Tx
Which drugs can be used for prophylactic management of migraines?
Propanolol
Topiramate
Amitriptyline
Which prophylactic migraine drug should be avoided in women of child bearing age?
Topiramate
Teratogenic + can reduce efficacy of hormonal contraceptives
What can be offered if drug prophylaxis of migraines fails?
A course of up to 10 sessions of acupuncture over 5-8w
What can be used for women with predictable menstrual migraine?
Frovatriptan (2.5mg BD)
Zolmitriptan (2.5mg BD-TDS)
Which options may be considered by specialists for prophylaxis of migraine?
(outside NICE guidelines)
Candesartan
Monoclonal antibodies e.g. Erenumab
What are the complications of migraine
Disruption of daily activities
Can lead to analgesia-overuse headaches in people who use analgesia regularly
What is the prognosis for patients with migraine?
Usually CHRONIC
Most cases can be managed well with preventative/ early Tx measures
