Migraine Flashcards
Define Migraine?
Severe episodic headache that may have a prodrome of focal neurological symptoms (aura) and is associated with systemic disturbance
How do we classify Migraine?
Migraine with aura (classical migraine) Migraine without aura (common migraine) Migraine variants (e.g. familial hemiplegic, ophthalmoplegic)
What is the aetiology of Migraine?
Early aura of cortical spreading depression is associated with intracranial vasoconstriction leading to localised ischaemia
This is then followed by meningeal and extraranial vasodilation mediated by serotonin, bradykinin and the trigeminovascular system
What is the epidemiology of Migraine?
Prevalence:
- Males (6%)
- Females (15-20%)
Usually occurs in adolescence and early adulthood
What is the nature of the headache in Migraine?
Pulsatile
Duration: 4-72 hrs
Episodic
Chronic daily headaches lasting weeks would suggest a different aetiology
What are the associated symptoms of Migraine?
Nausea
Vomiting
Photophobia/Phonophobia
Aura
What sort of symptoms are included in an Aura?
Flashing lights Spots Blurring Zigzag lines Blind spots (Scotomas) Tingling/numbness in the limbs
What are the triggers and risk factors for Migraine?
Stress Exercise Lack of sleep Oral contraceptive pill Foods (e.g. caffeine, alcohol, cheese, chocolate)
What are the signs of Migraine on physical examination?
NO specific physical findings
Exclude secondary causes with MMSE, neurological examination, fundoscopy, etc.
What investigatiosns do we do for Migraine?
Diagnosis is usually based on history
Investigations may be useful for excluding other diagnoses
Bloods, CT/MRI, lumbar puncture
What is the Acute Management plan for Migraine?
NSAIDs Paracetamol Codeine Antiemetics Triptans (5-HT agonsits) - e.g. sumatriptan
Why do we have to be careful with the management plan for Migraine?
Analgesia overuse can cause headaches
What is the prophylaxis management plan for Migraine?
B-blockers Amitriptyline Topiramate Sodium valproate Menstrual migraines can be controlled with the oral contraceptive pill
What advice do you give to someone who suffers from Migraine?
Avoid triggers
Rest in a quiet dark room during episodes
What are the possible complications of Migraine?
Disruption of daily activites
Can lead to analgeisa-overuse headaches in people who use analgesia regularly
