Migraine

Question 1

Define migrains

Answer 1

Primary headache disorder -> intense unilateral pulsating headaches preceded by an aura

Question 2

What are the key features of a migraine headache?

Answer 2

Debilitating
Unilateral
Puslating
Preceded by an aura -> manifest as visual or sensory changes
Pain lasts 4-72hours
Accompanied by nausea, vomiting, photophobia, phonophobia

Question 3

What is the key epidemiology of migraines?

Answer 3

12% global pop
Three times more common in women -> hormonal
Peak 30-39yrs

Question 4

What are some potential triggers for migraines?

Answer 4

Foods
Changes in weather
Stress
Hormonal changes
Meds -> oral contraceptives

Question 5

What is the International Headache society criteria for migraine without aura?

Answer 5

A - five attacks fulfilling B-D
B - leasting4-72hrs untreated
C - two of unilateral, pulsatile, mod to severe pain, aggregation or routine physical activity
D - During headache - nausea/vom or photophobia/phonophobia
E - no other better diagnosis

Question 6

What are the key differentials for migraine?

Answer 6

Tension headahce - bilateral, band like, constant
Cluster - severe, unilateral, orbital or temporal 15-180mins, 8 times a day, autonomic symptoms
Subarachnoid hemorrhage - worst headache of my life
Giant cell artitiris - new 50yrs+, scalp tenderness, jaw claudication, elevated ESR and CRP.

Question 7

What investigations may be done to help diagnose a migraine?

Answer 7

Headache diary
Neuroimaging or bloods (ESR, CRP) to rule out differentials

Question 8

What is the acute management for migraines?

Answer 8

Avoid triggers
Triptans - avoid if IHD - mimic seratonin decrease pain and constrict BV
Paracetamol/NSAID
Anti-emetics - metoclopramide

Question 9

What should be considered in female patients with migraine aura as a contraindicated medication?

Answer 9

Combined oral contraceptive pill
Due to increased risk of ischaemic stroke.

Question 10

What medical prophylaxis can be given for migraines?

Answer 10

Propranolol - contraindicated in asthma
Topiramate
Amitriptyline
Candesartan

Question 11

What non drug treatment can be given as prophylaxis for migraines?

Answer 11

Greater occipital nerve block
Botulinum toxin injection

Question 12

When is rimegepant used to treat migraines?

Answer 12

Preventing episodic migraine
Suitable when 3 preventative treatments have failued
Adults with 4-15 migrains per months

Question 13

What patient education is needed with acute migraine medication?

Answer 13

Medication overuse headache
From taking triptans/NSAIDs etc for more than 10-15days per months.