migraines Flashcards
what are the symptoms of migraine with aura
- visual symptoms (zigzag or flickering lights, spots, lines, or loss of vision)
- sensory symptoms (pins and needles, or numbness)
- dysphasia (difficulty swallowing)
these symptoms come before the onset of headache and usually resolve within 1 hour
what are the symptoms of the headache in a migraine
headache is usually:
- unilateral (on one side of the head)
- pulsating
- aggravated by routine physical activity, and may be severe enough to impact or prevent daily activities.
It is frequently accompanied by nausea and vomiting, photophobia (sensitive/uncomfortable/painful when exposed to light) and phonophobia (intolerance/hypersensitivity to sound) , or both.
what is a chronic migraine
headache which occurs on at least 15 days per month and has the characteristics of a migraine headache on at least 8 days per month for greater than 3 months
- headache for less than 15 days/month is an episodic migraine
what can trigger a migraine in women
the drop in oestrogen levels just before menstruation is a trigger for migraine.
symptoms generally occur from two days before the start of bleeding up until three days after
how can medication overuse cause migraines
the frequent use of acute treatment for migraine increases the frequency and intensity of headache, and can become the cause of the headache
how do patients who suffer from migraines reduce the risk of developing medication-overuse headache
acute migraine treatment should ideally be restricted to 2 days per week
what is the first line treatment for acute migraines and when should this be taken
first line: aspirin, ibuprofen, or a 5HT1-receptor agonist (e.g sumatriptan)
- treatment should be taken as soon as the patient knows that they are developing a migraine (start of headache phase). i
- if they patient experiences aura, ensure to take 5HT1-receptor agonist at the start of the headache not aura (if it comes before the headache)
what is the first choice 5HT1-receptor agonist for acute migraines
sumatriptan
other alternatives: naratriptan, rizatriptan, and zolmitriptan
which NSAIDs can be used for acute migraines
- aspirin, ibuprofen, naproxen (unlicensed), diclofenac, tolfenamic acid
what is the next step if monotherapy fails for acute migraines
can give sumatriptan + naproxen
which antiemetics can be used to relive nausea + vomiting during a migraine
Prochlorperazine + Metoclopramide (not to be used regularly due to extrapyramidal side effects)
what is the first-line preventative treatment in patients with episodic or chronic migraine
Propranolol
- if unsuitable other beta-blockers can be used such as metoprolol, atenolol [unlicensed indication], timolol, Bisoprolol
which drug can be given if beta blockers are not tolerated for preventative treatment for migraines
Topiramate, however it is teratogenic so if women of childbearing age are using it, need to be on PPP (pregnancy prevention programme)
How long should you wait before deciding if preventative treatment for migraines has been effective?
what is determined as a good response to treatment
Preventative treatment should be tried for at least 3 months at the maximum tolerated dose, before deciding whether or not it is effective
A good response to treatment is defined as a 50% reduction in the severity and frequency of migraine attacks.
when would you use Botulinum toxin type A to manage migraines
for prophylaxis of chronic migraine where medication-overuse has been addressed and where 3 or more oral prophylactic treatments have failed.
