Migraine

Question 1

Headache - overview

Answer 1

1. Primary headaches
   - Migraine
   - Tension-type headache
   - Cluster headache
   - Other
2. Secondary headaches
   - Head/neck trauma
   - Infection
   - Substance or its withdrawal
   - Cranial or cervical vascular disorder (vascular malformation or intracranial haemorrhage)
   - Non-vascular intracranial disorder (raised ICP, idiopathic intracranial hypertension
3. Cranial neuralgias, central and primary facial pain and other headaches

Question 2

Migraine - background

Answer 2

1. Definition = periodic episodes of paroxysmal headache + N/V + abdominal pain + relief with sleep
2. Epi = up to 10%
3. If occur frequently (>4/mo for >3mo), dx unlikely

Question 3

Migraine - dx

Answer 3

Migraine without aura
A. At least 5 attacks fulfilling B-D
B. Headache attack lasting 1-48hrs
C. Headache has at least two of the following:
1. Bilateral (temporal or frontal) or unilateral location
2. Pulsating quality
3. Moderate to severe intensity
4. Aggravation by routine physical activity
D. During headache, at least one of the following:
1. Nausea and/or vomiting
2. Photophobia and/or phonophobia

Migraine with aura
A. Headache that lasts 1-48hrs
B. At least two attacks fulfilling C
C. At least three of the following:
1. One or more fully reversible aura symptoms indicating focal cortical and/or brainstem dysfunction
2. At least one aura gradually developing over >4min, or two or more symptoms occurring in succession
3. No aura lasting >60min
4. Headache follows in

Question 4

Migraine - mx

Answer 4

1. Often resolve with 2-3 hours of sleep. Ibuprofen or paracetamol (orally) can be given, and is often all that is required
2. Avoid aspirin in children