migraine

Question 1

definition

Answer 1

Migraine is a chronic, genetically determined, episodic neurological disorder that usually presents in early-to-mid life. Key features in the history that support a diagnosis of migraine are nausea, photophobia, and disability, along with headache. Typical migraine aura (a complex of reversible visual, sensory, or speech symptoms), which occurs during or precedes headache, is pathognomonic of migraine but only occurs in 15% to 30% of patients.

Question 2

symptoms

Answer 2

• prolonged headache (4-72hr if untreated)
• nausea
• decreased ability to function
• worsens with activity (compared to e.g. tension headache which doesn’t worsen with activity)
• photophobia
• phonophobia (sound)
• aura

Question 3

risk factors

Answer 3

• fhx of migraine
• high caffeine intake
• poor sleep/sleep disturbance
• stress
  (- overuse of headache medication)

Question 4

investigations

Answer 4

• (clinical diagnosis!)

Question 5

treatment

Answer 5

mild-moderate symptoms:
1. NSAID or aspirin
\+ metoclopramide (anti-emetic, where necessary)
2. paracetamol
3. paracetamol/aspirin/caffeine

severe symptoms:
1. sumatriptan (5HT1 agonist)
+ metoclopramide where needed

migraine meds are split into: meds for acute episodes/ prophylactic meds.
Rizatriptan and other triptans are used only in acute attacks. Diclofenac may also be used in acute attacks.
Medications used as prophylaxis or as preventative measures include propranolol, amitriptyline and pizotifen.

Question 6

complications

Answer 6

• status migrainosus
• migrainous infarction
• migraine triggered seizures
• depression
• chronic migraine
• persistent aura without infarction

Question 7

contraindications of triptans (5H1T agonists)

Answer 7

triptans cause vasoconstriction!!

• ischaemic heart disease
• uncontrolled hypertension
• > 65, <12 y/o
• use of ergotamine preparations or vasoconstrictor drugs in general
• use of methysergide prescribed for prevention of migraine (because methysergide also has vasoconstrictor properties)