Migraine Flashcards
What is the definition of migraine?
Severe throbbing pain or pulsing sensation, usually on one side of the head.
What are some triggers for migraines?
Sleep
Diet (chocolate)
Stress
Hormonal
Physical exertion
COCP
What are the types of migraine?
Migraine without aura (80%)
Migraine with aura (20%)
What is the pathophysiology of migraine without aura?
Stress triggers serotonin release
Blood vessels constrict an dilate
Chemicals like substance P irritate nerves and blood vessels causing pain
Sensitisation of trigeminal neurones and brainstem pain pathways making innocuous sensory stimuli painful
What is the pathophysiology of migraine with aura?
Cortical spreading depolarisation in migraine centre of brain (dorsal raphe nucleus, locus coeruleus)
Activation of trigeminal vascular system causing dilation of blood vessels
Release of substance P, neurokinin A, CGRP
Sensitisation of trigeminal neurones and brainstem pain pathways making innocuous sensory stimuli painful
What are some clinical features of migraine?
Unilateral throbbing headache preceded by visual (eg lines, zigzags) or sensory (eg spreading paraesthesia) auras
Headache may last 4-72 hours
Photophobia and phonophobia
What is the IHS criteria for migraine without aura?
At least 5 attacks
4-72 hours
2 of: moderate/severe, unilateral, throbbing pain, worse on movement
1 of: autonomic features, photophobia/phonophobia
What is the IHS criteria for migraine with aura?
Aura fully reversible visual, sensory, motor or language symptom
Aura duration 20-60 mins
Headache follows <1hr later
What are atypical migraines?
Acephalgic- no headache
Basilar- very nauseating, vertigo
Retinal, ophthalmic
Hemiplegic (familial/sporadic)
Abdominal (more common in young children)
What are some investigations for migraine?
Headache diary for identifying triggers
What is the non-medical management of migraine?
Education- avoid triggers
Headache diary
Relaxation/stress management
Set realistic goals
What is the acute medical management of migraine?
NSAID (aspirin, naproxen, ibuprofen) as early as possible
Triptans (sumatriptan, rizatriptan, eletriptan) at start of headache but not during aura phase
Antiemetic if gastroparesis
What is the prophylactic medical management of migraine?
1st line: amitriptyline or propanolol
2nd line: topiramate/valproate
3rd line: pizotifen
Consider acupuncture
When is prophylactic treatment for migraine considered?
If more than 3 attacks per month of very severe attacks
