Migraine

Question 1

What medications are used in prophylaxis of migraines?

Answer 1

Propranolol
Amitriptyline
Topiramate

Question 2

MOA of topiramate

Answer 2

Inhibits glutamate kainate and AMPA receptors

Also enhances GABA

Question 3

MOA of propranolol

Answer 3

Vasodilates vessels in brain to enhance blood flow

Question 4

MOA of amitriptyline

Answer 4

Inhibits the reuptake of noradrenaline and serotonin at respective nerve terminals

Question 5

What medications are used in acute presentations of migraines?

Answer 5

Triptans e.g. Rizatriptan

Question 6

When is prophylactic medication indicated?

Answer 6

If the migraines severely impair day to day life or are frequent (once a week)

Question 7

How are migraines described?

Answer 7

Throbbing

Question 8

Are the unilateral or bilateral?

Answer 8

Bilateral in 60% of cases

Question 9

What worses migraines?

Answer 9

Physical activity

Question 10

Epidemiology

Answer 10

Female>male

Question 11

Headache duration

Answer 11

4-72 hours

Recurrent episodes

Question 12

What makes it worse?

Answer 12

Aggravated by routine activities

Question 13

Associated symptoms?

Answer 13

Nausea
Photophobia
Phonophobia

Question 14

VIsual aura

Answer 14

Scotomoa - zig zag lines

Question 15

Sensory aura

Answer 15

Pins and needles

Question 16

What other auras are there?

Answer 16

Speech language symptoms

Atypical weird things like hemiparesis

Question 17

What meds?

Answer 17

Ibuprofen/aspirin/paracetamol
Triptans
Antiemetic

Question 18

What would you advise?

Answer 18

Acute medication should be taken early whilst pain is mild

Question 19

What might trigger a migraine?

Answer 19

Tiredness/stress
Alcohol 
Menstruation
Bright lights 
Food - see next slide

Question 20

Explain the relationship between food and migraines and what you should avoid

Answer 20

Lack of food or dehydration

Foods e.g. cheese, chocolate, red wines, citrus