Migraine Flashcards
What is the diagnostic criteria for migraines
At least 5 attacks which fulfil this criteria
- headaches lasting 4-72 hours
- Headaches with at least 2 of the following
unilateral location
pulsating quality
moderate/severe pain intensity
aggravation by/causing avoidance of physical activity
-during headache at least 1 of the following
nausea/vomitting
photophobia and phonophobia
-not attributed to another disorder– primary headache
What may someone with a migraine present with
Throbbing unilateral headache
nausea and vomitting
decreased ability to function
headache worsens with activity
photophobia
phonophobia
Aura
What may someone with a migraine appear like on examination
tenderness in scalp,neck and shoulder muscles
abnormal eye movements
changes in reflex and sensation
What investigations are required for a migraine
Clinical diagnosis
Neuroimaging , CT,MRI - may be needed to rule out other causes of headache
Blood tests- FBC, electrolytes and LFTs
What is acute management for a migraine
first line - offer combination therapy
An oral triptan and an NSAID
OR
an oral triptan and paracetamol
Which group do you offer nasal triptan for
young people aged 12-17 years old
If first line is not effective for acute management of migraine what should be offered next
non-oral preparation of
METOCLOPRAMIDE
PROCHLORPERAZINE
and consider adding a non-oral NSAID or triptan
caution with prescribing younger patients metoclopramide as acute dystonic reactions may develop
What are some prophylaxis management for migraines
Propranolol
Topiramate - avoided in women of childbearing age
Amitriptyline
Riboflavin may be effective in reducing migraine frequency and intensity in some people
How do you treat women with predictable menstrual migraine
Prophylaxis
- Frovatriptan 2.5mg twice a day
-Zolmitriptan 2.5mg twice/three times a day
How do you treat migraines during pregnancy
paracetamol as 1st line
NSAIDs can be used as second line in 1st and 2nd trimester
avoid aspirin and opiods
What can patients that have migraines with aura not be given
COC is contraindicated due to an increased risk of stroke
How should women who are menstruating and have migraines be treated
Mefanamic acid or combo of aspirin, paracetamol and caffeine
What is the relationship between HRT and migraines
safe to prescribe HRT but may worsen migraines
What are some complications associated with migraines
chronic migraine
medication overuse headache
depression and anxiety
reduced quality of life
