migraine

Question 1

beneficial habits for migraine

Answer 1

regular sleep schedules
minimal variation in blood glucose
adequate hydration
limited caffeinated beverages
regular exercise
good workplace ergonomics
regular use of relaxation techniques (eg. meditation, mindfulness, yoga, breathing techniques)
avoidance of specific triggers

Question 2

vitamins for headache

Answer 2

magnesium
riboflavin
coenzyme Q10

Question 3

non-pharmacological treatment

Answer 3

cold packs over the forehead or back of the skull (targetting the supraorbital and greater occipital nerves)
hot pack over the neck and shoulders (targetting innervation of the scalp)
neck stretches and self mobilisation
rest in a quiet dark room

Question 4

analgesia for migraine

Answer 4

non-opiod analgesic and metoclopramide

Question 5

triptan examples

Answer 5

sumatriptan (available intranasal or oral or subcut)
rizatriptan (dissolves on the tongue)
eletriptan (better tolerate, may have a milder acute effect)

Question 6

patients on triptans and SSRIs

Answer 6

rare issue of serotonin synrome
be aware of agitation, confusion, rapid heart rate, dilated pupils, muscle twitching, sweating, diarrhoea)

Question 7

prophylactic migraine medications

Answer 7

amitriptyline
candesartan
nortriptyline
pizotifen
propranolol
sodium valproate
topiramate
verapamil

Question 8

acephalgic migraine

Answer 8

aura without headache
ddx must exclude TIA or epilepsy
concerning sings include a first episode after the age of 40, exclusively negative symptoms (eg. hemianopia) or prolonged aura (more than 60 minutes)
presence of other migraine feaatures (eg. photophobia, phonophobia, nausea) may support the diagnosis