Migraine

Question 1

Define migraine

Answer 1

A migraine is usually a moderate or severe headache felt as a throbbing pain on one side of the head, and is associated with systemic disturbance. Episodic

Question 2

What are the 3 classes of migraines?

Answer 2

Can be classified as:

Migraine with aura (classical migraine)

Migraine without aura (common migraine)

Migraine variants (e.g. familial hemiplegic, ophthalmoplegic)

Question 3

Explain the aetiology/risk factors of migraine

Answer 3

Poorly understood

Early aura of cortical spreading depression is associated with INTRACRANIAL VASOCONSTRICTION leading to localised ischaemia

This is then followed by meningeal and extracranial vasodilation mediated by serotonin, bradykinin and the trigeminovascular system

Question 4

Summarise the epidemiology of migraine

Answer 4

Prevalence:

Males - 6%

Females - 15-20%

Usually occurs in adolescence and early adulthood

Question 5

Recognise the presenting symptoms of migraine

Answer 5

Headache

Pulsatile

Duration 4-72 hrs

Episodic

NOTE: chronic daily headaches lasting weeks would suggest a different aetiology

Question 6

What are the Associated Symptoms ?

Answer 6

Nausea
Vomiting
Photophobia/Phonophobia

Aura;
Flashing lights  
Spots  
Blurring  
Zigzag lines  
Blind spots (scotomas) 
Tingling/numbness in the limbs

Question 7

Triggers and Risk Factors of migraines?

Answer 7

Stress

Exercise

Lack of sleep

Oral contraceptive pill

Foods (e.g. caffeine, alcohol, cheese, chocolate)

Question 8

Recognise the signs of migraine on physical examination

Answer 8

NO specific physical findings

Exclude secondary causes with MMSE, neurological examination, fundoscopy etc.

Question 9

Identify appropriate investigations for migraine

Answer 9

Diagnosis is usually based on HISTORY

Investigations may be useful for excluding other diagnoses

Bloods, CT/MRI, lumbar puncture

Question 10

Generate a management plan for migraine

Hint, do a plan for;
acute, prophylaxis and advice

Answer 10

NOTE: analgesia overuse can cause headaches

1. ACUTE ;
NSAIDs 
Paracetamol 
Codeine  
Antiemetics  
Triptans (5-HT agonists) - e.g. sumatriptan -  (this is an abortive treatment, good or acute situation - doesnt reduce frequency of attacks)

2. Prophylaxis (these reduce FREQUENCY of attacks);
   b-blockers; Propanolol
   Amitriptyline
   Topiramate
   Sodium valproate
   Menstrual migraines can be controlled with the oral contraceptive pill
3. Advice
   Avoid triggers
   Rest in a quiet dark room during episodes

Question 11

Identify possible complications of migraine

Summarise the prognosis for patients with migraine

Answer 11

complications of migraine;

• Disruption of daily activities
• Can lead to analgesia-overuse headaches in people who use analgesia regularly

prognosis for patients with migraine;

• Usually CHRONIC
• Most cases can be managed well with preventative/early treatment measures