Migraine Flashcards
Migraine
Moderate/severe headahce
Throbbinf pain on one side of the head
Symptoms
- Intense throbbing headache on one side of the head
- N + V
- Sensitivity to light or sound
Aura (temporary warning signs before a migraine)
Visual disturbances
Numbness or pins and needles
Dizzy/off-balance
Difficulty speaking
Visual disturbances
- Flashing lights
- Zig zag patterns
- Blind spots
Numbness or pins and needles
Starts in one hand, moves up arm before affecting face, lips and tongue
Treatment
- 5-HT1 receptor agonists (triptans)
- NSAID
- Ergot alkaloids (rarely used)
Prophylaxis of migraine
Propranolol
Topiramate (AEDs)
Amitriptylline (TCAs)
Pizotifen
Ergot alkaloids
Ergotamine
- Do repeat in < 4 days
- Limited use to twice a month
- Peripheral vasospasm (stop if numbness/tingling of extremities occurs)
NSAID
Tolfenamic acid
- Specifically licensed to treat migraine attack
Management
1st line = simple analgesia
2nd line = 5-HT1 agonist
Alternatives = antiemetics, antihistamines
1st line
Paracetamol
- If doesn’t work, switch to NSAID (ibuprofen) or codeine if CI
- Still doesn’t work combine paracetamol + NSAID/codeine
2nd line
5-HT1A agonist
- If still experiencing frequent, prolonged attacks despite treatment combine with NSAID
Antiemetics
Metoclopramide
Domperidone
Antihistamines
Buclizine
Prochlorperazine
Prophalxis of migraine
e.g. propranolol
- Minimum 2 attacks per month
- Increasing frequency
- Significant disability despite treatment
- Cannot take suitable treatment for migraines.
