Migraine Flashcards
Describe migraine features
3:1 women
Severe unilateral throbbing headache
Nausea, photophobia, phonophobia
Attacks last up to 72 hours
Visual or other aura lasting 15-30 mins followed within 1h by headache
Typical aura are visual (chaotic distorting, jumbling lines, dots, zigzags, scotomata, hemianopia), can be motor (dysarthria, ataxia, ophthalmoplegia, hemiparesis, or speech - dysphasia
Can be isolated aura with no headache
Episodic severe headaches without aura
Yawning, cranings, mood/sleep change may precede attack
Give triggers of migraine
Chocolate Hangovers Orgasm Cheese, caffeine, red wine, citrus fruit Travel Tiredness Stress Dehydration Menstruation Bright light COCP
What are the diagnostic criteria for migraine?
5 full attacks
Headache lasting 4-72h
Headache has at least two of:
Unilateral, pulsating quality, moderate/severe pain, impairs routine activity
During headache
N/V or photophobia and photophobia
Not attributed to any other disorder
What are examples of aura
Typical aura are visual (chaotic distorting, jumbling lines, dots, zigzags, scotomata (jagged crescent), hemianopia), can be motor (dysarthria, ataxia, ophthalmoplegia, hemiparesis, or speech - dysphasia
Fully reversible
Develop over 5 mins
Last 5-60 mins
What is first line acute treatment
Combination therapy with oral triptan and NSAID or oral triptan and paracetamol
Nasal triptan in 12-17 year olds
Monotherapy or aspirin 900 may be considered
Rare side effects : arrhythmias or angina
Non-oral preparation of metoclopramide or prochlorperazine
What is used for prophylactic treatment of migraine?
If patients are having 2 or more attacks per month
Propanolol or topiramate
- topiramate is teratogenic so propanolol in women of child bearing age - can also reduce contraceptive effects
Amitryptiline can be used but this is off license
Gabapentin, valproate, pregabalin, ACE inhibitor may be of use
Last resort in 12 weekly botulinum toxin type A injections in chronic migraine
Riboflavin may be effective in reducing migraine frequency and intensity
Warm or cold packs
10 sessions of acupuncture over 5-8 weeks if both propanolol and topiramate are ineffective
What must you consider in migraines in females?
COCP increases risk of migraine
Use POP or non-hormonal contraception in migraine with aura
Increased risk of stroke if migraine with aura and COCP
What are triptans? What do they do? When to take?
ADRs? CI?
5HT1 and 5HT1 agonists
Inhibit release of substance P and pro-inflammatory neuropeptides, blocking transmission from the trigeminal nerve
Should be taken as soon as possible after onset of headache
Triptan sensation - tingling, heat, tightness, heaviness, pressure
CI - IHD/stroke risk or past hx
What is treatment for perimenstrual migraines?
In perimenstrual migrants, frovatriptan or zolmitriptan can be used on the days migraine is expected.
Mefanamic acid or combination of aspirin, paracetamol and caffiene
What is treatment for migraine in pregnancy?
Paracetamol
Aspirin 300
Or ibuprofen 400
