Migraine

Question 1

symptoms

Answer 1

visual or other aura 15-30 mins, followed within 1h unliteral throbbing headache. or no headache with aura. or episodic severe headaches without aura- premenstrual, unilateral, N+V, photo/phonophobia

Question 2

prodrome

Answer 2

precedes headache by hours/days- yawning, cravings, mood/sleep change

Question 3

aura

Answer 3

precedes headache by minutes may persist during it. visual- visual cascading, distorting, melting jumbling of lines. somatosensory- paraesthesia. motor- dysarthria, ataxia (basilar migraine), opthalmoplegia, hemiparesis. speech- dysphasia, paraphasia

Question 4

what is the criteria if no aura

Answer 4

> 5 headaches lasting 4-72 hours + N/V and any 2 of- pulsating, unilateral, impairs routine activity

Question 5

what may mimic migraine aura

Answer 5

TIAs

Question 6

treatment

Answer 6

NSAIDs- ketoprofen (100mg), dispersible aspirin (900mg/6h). triptans- rizatriptan, sumatriptan. ergots- Cafergot (ergotamine)

Question 7

contraindications and side effects triptans

Answer 7

CI- IHD, coronary spasm, uncontrolled incr in BP, recent lithium, SSRIs or ergot use. SE-arrhythmias, angina, MI.

Question 8

prevention migraine

Answer 8

1st line- propranolol, amitryptilline, topiramate, or Ca channel blockers. 2nd line- valproate, pizotifen, gabapentin, pregabalin, ACEi, NSAIDs

Question 9

what are women at risk of with combined pill

Answer 9

ischaemic stroke- if have migraine + aura have increase drick. risk augmented by smoking, age >35, BP high, obesity, diabetes mellitus, hyperlipidaemia

Question 10

why should you stop prophylaxis in pregnancy

Answer 10

most especially anti convulsants are teratogenic. start amitryptilline

Question 11

how do triptans work

Answer 11

5HT agonists- constricting cranial arteries. inhibit release of substance P, and pro inflam neuropeptides, blocking transmission from the trigeminal nerve to neurons