Migraine Flashcards
What is the postulate pathological mechanism behind migraine?
Cortical spreading depression propagated through electrophysiological depolarisation from the occipital pole. There is also intra-cerebral vasoconstriction and reactive vasodilation.
What are precipitants of migraine?
OCP, cheese, chocolate or red wine, relaxing after stress, menstruation, jet lag, flickering lights
What are symptoms of migraine?
aura lasting 15-30 mins followed by unilateral throbbing headache or no aura and severe headache
What are the clinical features of migraine
malaise, irritability, behavioural change, aura (neurological symptoms), headache is severe and throbbing, with photophobia, phonophobia and vomiting lasting from 4 to 72 hours, patient prefers to lie in a quiet, dark room.
How is migraine diagnosed?
If no aura - 5 or more headaches lasting 4-72hrs + nausea/vomiting (or photo/phonophobia) + any 2: of unilateral, pulsating or impairs routine activity
How is migraine managed acutely?
Triptan PO + NSAID/Paracetamol
What type of medication is triptan?
5-HT agonist
How is it managed prophylactically?
Propanolol 40-120mg/12h or Topirimate 25-35mg/12h
When should be topirimate be avoided?
In women of childbearing potential that topiramate as it is associated with a risk of fetal malformations (Cleft palate in first trimester) and can impair the effectiveness of hormonal contraceptives
Risk of what is increased with migraine + OCP?
Ischaemic stroke
What is 2nd line prophylactic treatment for migraine?
Acupuncture
