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AIP: Headache > Migraine > Flashcards

Migraine Flashcards

1
Q

Which groups of people are migraines common?

A

Women and young people

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2
Q

What is the typical time frame of migraines?

A

Episodic, usually lasts from several hours to 3 days (72h)

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3
Q

What is the character of the headache caused by migraine?

A

Severe unilateral throbbing (thumping, pulsatile, brain moving inside skull)

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5
Q

What may precede a migraine and over what time frame?

A

aura - can last for 20-30 minutes

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6
Q

What are 4 types of aura that can precede migraine? What may each involve?

A
  1. Visual aura: flashing lights or zig zag lines (scintillating scotoma), most common
  2. Sensory: paraesthesia in the hand spreading upwards to involve lips and tongue
  3. Motor: unilateral weakness
  4. Speech: dysphasia
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7
Q

What are 6 features associated with migraine headaches?

A
  1. Pain behind eye
  2. Headache worse with movement
  3. Nausea and vomiting
  4. Photophobia
  5. Phonophobia
  6. Sleep helps to relieve (lie in dark quiet room)
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8
Q

How common are specific triggers for migraine e.g. eating cheese?

A

Not common in clinical practice (contrary to public belief)

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9
Q

What explanations/ reassurance can you give to a patient diagnosed with migraines?

A

Full explanation of diagnosis and different treatment strategies; reassure nothing sinister causing headache

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10
Q

What investigations are indicated for migraine?

A

brain scan NOT indicated in majority of cases (but increasingly used for reassurance)

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11
Q

What are 3 approaches to the treatment of migraine?

A
  1. Avoiding triggers
  2. Treating acute attacks
  3. Preventative treatment - if >1 per month
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12
Q

When should preventative treatment be considered for migraines?

A

If patients experince 2 or more migraines a month

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13
Q

What are first and second line treatments of acute migraine attacks?

A
  • first line: oral triptan + NSAID or oral triptan + paracetamol
  • if not tolerated/ineffective: non-oral preparation of metoclopramide or prochlorperazine, consider adding non-oral NSAID or triptan
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14
Q

In what 3 forms do triptans exist to treat acute migraine attacks?

A
  1. Tablets
  2. Nasal spray
  3. Subcutaneous injections
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15
Q

What are 4 options for preventative treatment of migraine?

A
  1. Propranolol
  2. Topiramate
  3. Amitriptyline
  4. Botox injection - in certain patients with difficult migraine
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16
Q

What is the most common type of aura that precedes migraines?

A

visual aura

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17
Q

In what proportion of patients with migraine are headaches preceded by an aura?

A

1/3

18
Q

What are 2 common types of visual aura which precede migraines?

A
  1. Transient hemianopic disturbance
  2. Spreading scintillating scotoma (jagged crescent)
19
Q

What is the male:female ratio for migraines?

A

1:3

prevalence 6% in men, 18% in women

20
Q

What are 7 examples of migraine attack triggers?

A
  1. Tiredness, stress
  2. Alcohol
  3. Combined oral contraceptive pill
  4. Lack of food or dehydration
  5. Cheese, chocolate, red wine, citrus fruits
  6. Menstruation
  7. Bright lights
21
Q

Who developed the migraine diagnostic criteria?

A

International Headache Society

22
Q

What are 5 features of the IHS migraine diagnostic criteria?

A
  • A: at least 5 attacks fulfilling criteria B-D
  • B: attacks last 4-72h (untreated or unsuccessfully treated)
  • C: At least 2 of the following:
    • unilateral location
    • pulsating quality (varying with heartbeat)
    • moderate or severe pain intensity
    • aggravation by or causing avoidance of routine physical acitivity (e.g. walking, climbing stairs)
  • D: during headache at least 1 of:
    • nausea and/or vomiting
    • photophobia and phonophobia
  • E: not attributed to another disorder
23
Q

What are 3 ways in which migraines differ in children?

A
  1. Attacks may be shorter-lasting
  2. Headache more commonly bilateral
  3. GI disturbance more prominent
24
Q

How long prior to the headache may aura occur in migraine?

A

hours prior

25
Q

What are 5 atypical aura symptoms that may prompt further investigation/referral?

A
  1. Motor weakness
  2. Double vision
  3. Visual symptoms affecting only one eye
  4. Poor balance
  5. Decreased level of consciousness
26
Q

What class of drug are triptans?

A

5-HT1 agonists

27
Q

What formulation of triptans should be considered in young people aged 12-17 years?

A

nasal triptan (rather than oral)

28
Q

Which 2 options for preventative migraine prophylaxis are recommended by NICE?

A

propranolol or topiramate

29
Q

In which patient group should propranolol be used in preference to topiramate for migraine prophylaxis?

A

in women of child-bearing age - topiramate may be teratogenic, can reduce effectiveness of hormonal contraceptives

30
Q

If topiramate or propranolol fail to provide good prophylaxis against migraine, what do NICE recommend as the next treatment?

A

a course of up to 10 sessions of acupuncture over 5-8 weeks

31
Q

Which vitmain supplementation is recommended by NICE to consider advising patients with migraine to try reducing migraine frequency and intensity?

A

riboflavin (vitamin B2) 400mg once a day

32
Q

What type of treatment do NICE recommend for women with predictable menstrual migraine?

A
  • frovatriptan (2.5mg twice a day) or zolmitriptan (2.5mg twice or three times a day) - mini-prophylaxis
  • mefenamic acid or combo of aspirin+paracetamol+caffeine
33
Q

Why is pizotifen no longer recommended for migraine prophylaxis?

A

adverse effects such as weight gain and drowsiness are common

34
Q

What is the recommended management of migraine during pregnancy?

A

paracetamol 1g first line

NSAIDs can be used second line in first and second trimester only

(avoid aspirin and opioids)

35
Q

Why is migraine with aura a contra-indication to the COCP?

A

increased risk of stroke (relative risk 8.72)

36
Q

How should triptans be taken when prescribed for acute migraine attacks?

A

as soon as possible after onset of headache, rather than onset of aura

37
Q

What are 5 side effects of triptans?

A

triptan sensations:

  1. tingling
  2. heat
  3. tightness e.g. throat and chest
  4. heaviness
  5. pressure
38
Q

When are triptans contraindicated?

A

patients with history of or signidicant risk factors for IHD or cerebrovascular disease

AIP: Headache (10 decks)

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