Migraines

Question 1

Define a migraine

Answer 1

Unilateral pulsating and may be severe enough to impact daily activities. Frequently accompanied by nausea, vomiting, photophobia and phonophobia

Question 2

What are the symptoms of a migraine

Answer 2

Migraines can come with an aura which usually proceeds the onset of a headache
Visual symptoms: zigzag or flickering lights, spots, lines
Sensory symptoms: pins and needles and numbness
Dysphasia

Question 3

What lifestyle advice would you give someone with migraines

Answer 3

Maintain hydration, sleep and exercise
Avoid chocolate and wine
Relax after stress
A headache diary may be useful to identify potential triggers

Question 4

How do you treat an acute migraine

Answer 4

Treat with aspirin, ibuprofen, or a 5HT1-receptor agonist (sumatriptan favourable )

Take as soon as the patient knows they are having a migraine

With aura: Triptan taken at the start of the headache and not at the start of the aura

Triptan can be repeated after 2 hours (4 hours for naratriptan) ONLY if there has been a response to first dose but not fully adequate

Use soluble paracetamol if unable to take first line option- faster acting than normal paracetamol

Antiemetics may be needed: metoclopramide and prochlorperazine

Question 5

What is used for migraine prophylaxis

Answer 5

First line: propranolol
If contraindicated use metoprolol or nadalol

Amitriptyline is effective (can be a bit sedating)
Use less sedating TCA if Amitriptyline is not tolerated

Sodium valproate, pizotifen or Botox used normally under specialist care

Question 6

Moa of triptans

Answer 6

They constrict blood vessels so don’t use it in patients who have heart disease, and asthma and should use soluble paracetamol but not for hypertension patient as it has a lot of sodium

Question 7

What is a cluster headache

Answer 7

Intense unilateral pain in and around one eye
Acute: SC sumatriptan (nasal sumatriptan/ zolmitriptan given if unavailable)
Prophylaxis: verapamil, lithium, prednisolone or ergotamine tartate (rarely used)

Question 8

What is meant by trigeminal neuralgia

Answer 8

Severe facial pain like having an electrical shock in the jaw, teeth or gums
Treated with carbamazepine
Send them to A&E

Question 9

what is meant by a tension headache

Answer 9

Bilateral throbbing pain and like a tight band around your head
Paracetamol or ibuprofen

Question 10

What do you when a patient has subarachnoid haemorrhage

Answer 10

Send them to A&E
Sudden extreme pain at the back of their neck