Migraine

Question 1

What are the risk factors for migraine?

Answer 1

Family history
Female
Obesity

Question 2

What are the most common triggers for migraine?

Answer 2

Chocolate
Oral contraceptive
Alcohol
Anxiety
Travel
Exercise
Tiredness
Menstruation
Bright lights

Question 3

What are the features of migraine?

Answer 3

Unilateral
Pulsating
Nausea and vomiting
Photophobia and phonophobia
Aura

Question 4

What is a typical aura?

Answer 4

Develops over 5 minutes
Lasts 5-60 minutes
Can include:
- Visual symptoms
- Paraesthesia
- Speech disturbance

Question 5

What is an atypical aura?

Answer 5

Can last more than 60 minutes
May include:
- Visual symptoms affecting one eye
- Poor balance
- Decreased level of consciousness
- Motor weakness
- Diplopia

Question 6

What is the first line acute management of migraine?

Answer 6

Simple analgesia such as:
- 400mg ibuprofen
- 900mg aspirin
- 1g paracetamol

Question 7

What is the second line acute management of migraine?

Answer 7

Triptan alone or in combination with paracetamol/NSAID
- Sumatriptan is first choice

Question 8

Which triptans can be offered in patients < 18?

Answer 8

Nasal sumatriptan can be offered in children aged 12-17

Question 9

What is the first line prophylactic treatment of migraine?

Answer 9

Propranolol

Question 10

What is the second line prophylactic treatment of migraine?

Answer 10

Topiramate (teratogenic)
Amitriptyline