Migraine Flashcards
Define migraine
Severe episodic headache that may have a prodrome of focal neurological symptoms (aura) & is associated with systemic disturbance
Classification of migraines
2 main
Classical migraine = with aura
Common migraine = without aura
Aetiology of migraines
3
Poorly understood
Early aura of cortical spreading depression is associated with intracranial vasoconstriction leading to localised ischaemia
Followed by meningeal & extracranial vasodilation mediated by serotonin, bradykin & trigeminovascular system
Risk factors/triggers for migraine
5
Stress Exercise Lack of sleep Oral contraceptive pill Foods (e.g. caffeine, alcohol, cheese & chocolate)
Epidemiology of migraines
gender & age
More common in females
Usually occurs in adolescence & early adulthood
Presenting symptoms of migraine
main + 4
Headache
Nausea
Vomiting
Photophobia/phonophobia
Aura
Presenting symptoms of migraine - headache
3
Pulsatile
4-72hr duration
Episodic
Presenting symptoms of migraine - aura
6
Flashing lights Spots Blurring Zigzag lines Blind spots (scotomas) Tingling/numbness in the limbs
Signs of migraine on physical examination
general + 1
NO specific physical findings
Exclude secondary causes with MMSE, neuro exam, fundoscopy
Investigations for migraine
general +3
Diagnosis based on history - investigations may be useful to exclude other diagnoses
Bloods, CT/MRI, lumbar puncture
Management of migraine - acute
5
NSAIDS Paracetamol Codeine Antiemetics Triptans (e.g sumatriptan)
Management of migraine - prophylaxis
5
β-blockers Amitriptyline Topiramate Sodium valproate Menstrual migraines can be controlled by oral contraceptive pill
Management of migraine - advice
2
Avoid triggers
Rest in quiet dark room during episodes
Complications of migraines
2
Disruption of daily activities
Analgesia-overuse headaches
Prognosis of migraine
2
Usually CHRONIC
Most cases can be managed well with preventative/early treatment measures
