Migraine

Question 1

What are the characteristic features of a migraine headache?

Answer 1

• Severe, unilateral, throbbing headache
• Associated with nausea, photophobia, phonophobia
• attacks may last up to 72 hours
• precipiated by an aura: visual, progressive 5-60 minutes and characterised by transient hemianopic disturbance or scotoma

Question 2

What are common triggers of a migraine attack?

Answer 2

• Tiredness, stress
• alcohol
• COCP
• bright lights
• menstruation
• lack of food or dehydration

Question 3

What is required to diagnose migraine?

Answer 3

At least 5 attacks fulfilling criteria B-D

*B: headache lasting 4-72hours

*C: Headache has at least 2 of the following
>unilateral location
>pulsating quality
>moderate/severe pain
>aggravation by or causing avoidance of routine physical activity

*D: One of the following
>nausea and or vomiting
>photophobia & phonophobia

*E: not attributed to another disorder

Question 4

What is the acute treatment of a migraine?

Answer 4

First line:
>Oral triptan and an NSAID or
>Oral triptan and Paracetamol

2nd:
>if not effective or not tolerated can offer non-oral prep of metoclopramide or prochlorperazine and cosider adding non-oral NSAID

Question 5

When should prophylaxis treatment be given for migraines?

Answer 5

2 or more attacks per month

Question 6

What prophylaxis treatment can be offered for migraines?

Answer 6

• 1st line: Propranolol
• 2nd: Topiramate (not to women as teratogenic)
  3rd: Acupuncture