Migraine

Question 1

What is the definition of a migraine?

Answer 1

Severe episodic headache that may have a prodrome of focal neurological symptoms (aura) and is associated with systemic disturbance.

Question 2

What are the different classifications of migraines?

Answer 2

Migraine with aura (classical migraine)

Migraine without aura (common migraine)

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

Question 3

What is the aetiology and risk factors involved with migraines?

Answer 3

It is poorly understood

The early aura of cortical spreading depression is associated with intracranial vasoconstriction -> localised ischaemia

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

Question 4

Epidemiology of migraines

Answer 4

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

- Associated symptoms: 
Nausea  
Vomiting 
Photophobia/Phonophobia 
Aura

- Triggers and risk factors: 
Stress  
Exercise  
Lack of sleep  
Oral contraceptive pill  
Foods (e.g. caffeine, alcohol, cheese, chocolate)

Question 6

What are the different aura that can present with migraine?

Answer 6

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

Question 7

What are the signs of migraine on physical examination?

Answer 7

NO specific physical findings

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

Question 8

What are the appropriate investigations for migraine

Answer 8

Diagnosis is usually based on HISTORY

Investigations may be useful for excluding other diagnoses

Bloods, CT/MRI, lumbar puncture

Question 9

What would be the appropriate management for migraines?

Answer 9

• ACUTE: NSAIDs, Paracetamol, Codiene, Antiemetics, Triptans (5HT antagonists - sumatriptan
• Prophaylaxis - B blockers, Amitriptyline, Topiramate, Sodium valproate, menstrual migraines can be controlled with oral contraceptive pill
• Advice: Avoid triggers and rest in a quiet dark room during episodes

Question 10

What are the ossible complications of migraines?

Answer 10

Disruption of daily activities

Can lead to analgesia-overuse headaches in people who use analgesia regularly

Question 11

Prognosis for patients with migraine

Answer 11

Usually chronic

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