Migraine

Question 1

What are the clinical features of a migraine?

Answer 1

LOCATION : Unilateral or Bilateral
PAIN : Pulsating, intense
OTHER SYMPTOMS : Aura (Eyes = visual spots/lines, flickering lights, loss of vision; Other = numbness, pins and needles, speech disturbance), sensitive to light/sound, nausea and vomiting
DURATION : 4-72 hrs in adults (1-72 hrs in teenagers)

Question 2

What are the risk factors for a migraine?

Answer 2

Female, FHx, caffeine, obesity, habitual snoring, stress, overuse of headache medications, sleep deprivation

Question 3

How do you treat an ongoing migraine?

Answer 3

Combination therapy = Triptan + NSAID or other Triptan + Paracetamol;
Single drug therapy = Triptan, NSAID, Paracetamol, Aspirin

Consider anti-emetic.

Question 4

What are the prophylactic treatments for a migraine?

Answer 4

Topiramate OR Propranolol, amitriptyline, riboflavin (effective in some patients)