migraines

Question 1

types of migraines

Answer 1

classic migraine - unilateral, pulsating, impacts daily activities - accompanied by n&v, photophobia, phonophobia

migraines with aura
- aura that precedes the onset of the headache
- visual symptoms (zigzag or flickering lights)
- sensory symptoms (pins and needles, numbness)
- dysphasia - speech impairment

epsiodic migraine - less than 15 days a month

chronic - headache occurs on at least 15 days per month

Question 2

lifestyle advice

Answer 2

maintain hydration, sleep exercise

avoid chocolate and wine

avoid stress

headache diary useful to identify potential triggers

Question 3

acute treatment of migraines

Answer 3

1st line - aspirin, ibuprofen or 5ht1 agonist - sumatriptan favoured

take as soon as pt knows they are developing migraine

with aura - take at start of headache not at the start of the aura

triptans - can be repeated after 2hrs (4hrs for naratriptan) only if there was response to 1st dose but inadequate

soluble paracetamol can be used if first line not available - faster onset of action

antiemetics can be used - metoclopramide, prochlorperazine,
domperidone

Question 4

migraine prophylaxis

Answer 4

1st line propranolol
- if c/i - metoprolol or nadalol

topiramate - PPP must be met

amitriptyline is effective
- use less sedating tca is cant tolerate

CGRP inhibitor - atogepant, rimegepant if at least 3 treatments have been ineffective

sodium valproate (>55), pizotifen, botox - specialist

Question 5

sumatriptan contraindicated in?

Answer 5

people with uncontrolled hypertension, CVD

as works by constricting blood vessels

Question 6

treatment and prophylaxis in cluster headaches

Answer 6

cluster - intense unilateral pain in or around 1 eye

acute - nasal sumatriptan/zolmitriptan, SC sumatriptan

prophylaxis - verapamil, lithium or prednisolone

Question 7

treatment of trigeminal neuralgia

Answer 7

severe facial pain like electric shock in teeth, jaw, gums

treatment - carbamazepine

Question 8

tension headache treatment

Answer 8

most common
bilateral throbbing pain - like tight band around head

treatment - paracetamol or ibuprofen

Question 9

what to do if someone experiences sudden severe headache and neck pain - may have nausea, confusion, vision problems

Answer 9

refer to A&E straight away

symptoms of subarachnoid haemorrhage