Migraine

Question 1

Headache red flags

Answer 1

Sudden onset
New and >50 YO
Abnormal neurology
Affected by posture, couch, sneeze
Fever
Hx HIV/cancer

Question 2

Diagnosis of migraine

Answer 2

Headaches 4-72h long
2 of unilateral/pulsatile/painful/reduced activity
N&V or photophobia&phonophobia
No other Dx

Question 3

Pathology of migraine

Answer 3

Reduced blood to brainstem (CN V) nuclei
Vasocactive peptides released at CN V nucleus
Cortical spreading depression spreads to pia, dura and venous sinuses
Low serotonin, reduced inhibition of descending painful pathways

Question 4

Types of migraine

Answer 4

Classic (aura)
Common (no aura)
Variant (unilateral/motor or sensory symptoms)

Question 5

Management of mild acute migraine

Answer 5

Simple analgesia (NSAID/PCM- NOT Opioid)
Antiemetic (metoclopramide)

Question 6

Management of acute severe migraine

Answer 6

Triptans (5HT 1b/1d agonists)- not if CVD

Local nerve block (superior orbital/greater occipital)

Question 7

Preventive therapy for migraine

Answer 7

Propanolol (not if asthmatic, ow BP, low HR, DM, severe PVD) Start low go slow
Antidepressants (Amytriptilline is sedative)
Anticonvulsants (Gabapentin, Topoipomerate, Valproate )
No valproate in pregnancy