Migraine

Question 1

How does a migraine typically present?

Answer 1

A pulsatile, severe headache with nausea and photophobia

Question 2

Which sex is migraine more commonly seen in?

Answer 2

Females

Question 3

On average, how many migraines a month do sufferers usually have?

Answer 3

One

Question 4

How common is it to have aura?

Answer 4

20% of migraine sufferers will have aura

Question 5

How quickly does a migraine headache develop?

Answer 5

30 minutes - a few hours

Question 6

What is the most characteristic feature of a migraine?

Answer 6

Aggravation of pain by movement

Question 7

What are the behaviours of someone with a migraine?

Answer 7

They will prefer to lie down in a dark and quiet room

Question 8

What is a migraine prodrome?

Answer 8

A period before a migraine which can last for several days leading up to the headache and may include aura symptoms e.g. visual disturbance, altered mood, tiredness

Question 9

What are some features of a migraine postdrome?

Answer 9

Altered mood, appetite change and fatigue

Question 10

For a migraine without aura to be diagnosed, how many attacks should a person have had? How long should they have lasted?

Answer 10

At least 5 episodic attacks with a duration of 4-72 hours

Question 11

For a migraine without aura to be diagnosed, what features should the person have at least two of?

Answer 11

Moderate-severe intensity, unilateral, throbbing pain, worse on movement

Question 12

For a migraine without aura to be diagnosed, what features should the person have at least one of?

Answer 12

Autonomic features, photophobia, phonophobia

Question 13

What type of influences cause migraine in susceptible individuals?

Answer 13

Vascular and neuronal

Question 14

What are some factors which may make individuals susceptible to migraines?

Answer 14

Genetic or hormonal influences

Question 15

In the pathophysiology of migraine, stress triggers changes in the brain which causes which chemical to be released?

Answer 15

Serotonin

Question 16

What is the migraine aura?

Answer 16

A period of around 20-60 minutes before the headache in which there is fully reversible visual, sensory, motor or language symptoms

Question 17

How long after the aura does the headache of a migraine usually occur?

Answer 17

About an hour after, but the two can coincide

Question 18

What is the most common type of aura?

Answer 18

Visual

Question 19

What are some factors which may trigger a migraine?

Answer 19

Sleep, dietary (chocolate, cheese, alcohol), stress, hormones (menstruation), physical exertion

Question 20

What is a useful management option which can be used to identify migraine triggers?

Answer 20

Headache diary - record the frequency, severity, nature and associated symptoms of migraine

Question 21

Are investigations generally needed for a typical presentation of migraine?

Answer 21

No

Question 22

What are some non-pharmacological treatment options for migraine?

Answer 22

Avoidance of triggers, headache diary, stress management, acupuncture

Question 23

What are some first line medications for the acute treatment of migraine?

Answer 23

Simple analgesia (paracetamol/NSAID) and anti-emetic (metaclopramide/domperidone)

Question 24

What is a second line medication for the acute treatment of migraine?

Answer 24

Triptans

Question 25

What NSAIDs can be used in the acute treatment of migraine?

Answer 25

Aspirin 900mg/Naproxen 250mg/Ibuprofen 400mg

Question 26

When should an analgesic be taken for acute migraine?

Answer 26

As early as possible, when the aura occurs or when the headache starts (whichever occurs first)

Question 27

Do NSAIDs give complete pain relief from migraines?

Answer 27

Only 25% of the time (though there is a significant reduction in the headache at 2 hours)

Question 28

What type of drug are triptans? How can they be administered?

Answer 28

5-HT agonists / orally, sublingually or subcutaneously

Question 29

When should triptans be taken for acute migraine?

Answer 29

When the headache starts

Question 30

Why is Frovatriptan given over other triptan drugs in the treatment of migraine?

Answer 30

Sustained relief- it will last longer

Question 31

When is migraine prophylaxis given?

Answer 31

If there are more than 3 attacks per month or attacks are particularly severe

Question 32

How should prophylactic drugs for migraine be started?

Answer 32

At low doses and then titrated up

Question 33

Each drug given as migraine prophylaxis should be trialled for how long?

Answer 33

4 months

Question 34

What are some drugs which can be given as migraine prophylaxis?

Answer 34

Propranolol, topiramate, amitriptyline

Question 35

Propranolol for migraine prophylaxis should be started at which dose? What are some side effects?

Answer 35

80mg od / can cause lightheadedness and nightmares

Question 36

Propranolol should be avoided in patients with what other conditions?

Answer 36

Asthma, PVD, heart failure

Question 37

What type of drug is topiramate? At what dose should it be started for migraine prophylaxis?

Answer 37

Anti-epileptic / 25mg od

Question 38

What are some side effects of topiramate?

Answer 38

Weight loss, paraesthesia, impaired concentration, depression

Question 39

At what dose should amitriptyline be started for migraine prophylaxis?

Answer 39

10-25mg

Question 40

What are some side effects of amitriptyline?

Answer 40

Dry mouth, sedation, postural hypotension

Question 41

If prophylactic therapies for migraine are ineffective, what other treatments can be used?

Answer 41

Greater occipital nerve block or botox type A injections

Question 42

What are some lifestyle changes that can be used for migraine prophylaxis?

Answer 42

Balanced diet with regular intake and avoidance of triggers, 2l of hydration daily with decreased caffeine, decrease stress and regular exercise