Migraines Flashcards
2 Causes of migraine
- Drop in oestrogen before menstruation
- Medication over-use (of acute migraine treatment)
Lifestyle advice for migraines
Maintain hydration, sleep and exercise
Relax after stress
Avoid chocolate and wine
Headache diary to identify triggers
First line treatment
NSAIDs (ibuprofen, aspirin)
Second line treatment
5-HT1 Receptor Agonists (triptans)
- sumatriptan tried first
What antiemetics can be used for migraine nausea?
Metoclopramide or prochlorperazine
- as a single dose at headache onset
Why shouldn’t metoclopramide be used long term?
Risk of extrapyramidal side effects
What treatment can be considered for severe vomitting?
Diclofenac suppositories
First line preventative treatments
Propranolol (or another beta blocker)
Other medications for preventative treatments
Topiramate, amitriptyline, candesartan
Sodium valproate, pizotifen, botox - specialist initiated
How many preventative treatments should be tried before specialist referral?
3 unsuccessful drugs
Side effects of Triptans
Headache
Flushing
Hot/cold sensations
Drowsiness
Contraindications of Triptans
Mild uncontrolled hypertension
Previous TIA
Previous MI
Heart disease
When during a migraine should sumatriptan be taken and when should the second dose be taken?
At the start of headache (not aura)
Second dose should be taken 2 hrs after first (if response inadequate)
