Migraine

Question 1

Types

Answer 1

With aura, without aura, silent, hemiplegic

Question 2

Stages

Answer 2

Prodromal (can be a few days before) (food cravings, mood changes, fatigue)
Aura (up to 60 mins)
Headache (4-72 hrs)
Resolution
Recovery

Question 3

Features (symptoms)

Answer 3

Phonophobia
Photophobia
Osmophobia
Aura
Unilateral, pulsating headache
Aggravated by activities of daily living
Nausea and vomiting

Question 4

Types of aura

Answer 4

Vision
Sensation (tingling, numbness)
Language (dysphasia)

Question 5

Explain a hemiplegic migraine

Answer 5

Hemiplegia, with or without ataxia and/or impaired consciousness.
Essential to exclude a stroke as it can mimic these

Question 6

Triggers

Answer 6

Bright light
Loud noise
Smells
Food e.g. chocolate, caffeine
Stress
Dehydration
Menstruation
Trauma
Disrupted sleep

Question 7

Acute management

Answer 7

Fluids
NSAIDs
Paracetamol
Triptans
Antiemetics (metoclopramide or prochlorperazine)
AVOID OPIOIDS

Question 8

MOA of triptans
C/I of triptans

Answer 8

Act on 5-HT1B and 5-HT1D receptors to increase serotonin in the brain.
Causes cranial vasoconstriction, reduces release of inflammatory neuropeptides and reduces transmission of pain signals
Avoid in hypertension, CAD, previous stroke, TIA or MI

Question 9

Prophylaxis

Answer 9

Propranolol
Amitriptyline
Topiramate

Specialist options:
Pizotifen
Candesartan
Sodium valproate
Monoclonal antibodies

Other options include:
CBT
Acupuncture
Vitamin B2
Mindfulness and meditation
Greater occipital nerve block

Botox - must have failed on 3 preventers. Works by inhibiting the release of peripheral nociceptive neurotransmitters

Question 10

Treatment if <18 years

Answer 10

Nasal triptan

Question 11

SEs of pizotifen

Answer 11

Weight gain
Drowsiness

Question 12

Treatment in pregnancy

Answer 12

Paracetamol 1st line
NSAIDs 2nd line only if first/second trimester

Question 13

Can HRT be prescribed if Hx of migraine?

Answer 13

Yes however may make migraines worse