Migraine

Question 1

What is a migraine?

Answer 1

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

Question 2

How can migraine be subclassified?

Answer 2

With aura (classic)
Without aura (common migraine)
Migraine variants (familial hemiplegic, opthalmoplegic + basilar).

Question 3

Describe the proposed pathophysiology of migraine

Answer 3

Intracranial vasoconstriction resulting in localized ischaemia.
Followed by meningeal + extracranial vasodilation mediated by 5-HT, bradykinin + the trigeminovascular system.

Question 4

Describe the epidemiology of migraine

Answer 4

F > M 3:1.

Usual onset in adolescence/ early adulthood, but can occur in middle age.

Question 5

List 3 symptoms of migraine

Answer 5

N+V
Photophobia/ Phonophobia
Aura: Flashing lights, Spots, Blurring, Zigzag lines, Blind spots, Tingling/ numbness in limbs

Question 6

List 5 triggers/ risk factors for migraine

Answer 6

Stress  
Exercise  
Lack of sleep  
OCP
Foods (e.g. caffeine, alcohol, cheese, chocolate)

Question 7

Describe the headache in migraine

Answer 7

Pulsatile
Unilateral
Duration 4-72h
Episodic

Question 8

List signs of migraine

Answer 8

NO specific physical findings

Question 9

Describe investigations for migraine

Answer 9

Dx is usually based on HISTORY
Exclude secondary causes with MMSE, neurological examination, fundoscopy etc.
Bloods: FBC, ESR
CT/ MRI: If suspicion of secondary headache disorders
Lumbar puncture: If suspicion of meningitis. DON’T perform until space-occupying lesion excluded.

Question 10

List 5 drugs that may be used in acute management of migraine

Answer 10

Antiemetics (e.g. metoclopramide). 
NSAIDs (e.g. naproxen)
Paracetamol 
Codeine  
Triptans (5-HT agonists) - e.g. sumatriptan

Question 11

List 5 drugs that may be used in prophylactic management of migraine

Answer 11

b-blockers  
Amitriptyline  
Topiramate  
Sodium valproate 
Menstrual migraines can be controlled with the OCP

Question 12

List 5 drugs that may be used in prophylactic management of migraine

Answer 12

b-blockers  
Amitriptyline  
Topiramate  
Sodium valproate 
Menstrual migraines can be controlled with OCP

Question 13

What are the complications of migraine

Answer 13

Disruption of daily activities

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

Question 14

What is the prognosis for patients with migraine?

Answer 14

Usually CHRONIC

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