Migraines

Question 1

What type of medication is used to treat an acute migraine?

Answer 1

5-HT receptor AGONIST. (Triptans)

Question 2

What type of medciation is used in the prophylaxis of migraines?

Answer 2

5-HT receptor ANTAGONISTS

Question 3

What vitamin can be helpful in reducing symptoms?

Answer 3

Riboflavin (400mg OD)

a.k.a. Vitamin B2

Question 4

What is the treatment pathway for acute migraine headaches?

Answer 4

First line - oral triptan + an NSAID or Paracetamol

Second line - Metoclopramide or prochloperazine + Non-oral NSAID or Triptan.

(Second line is presuming delayed gastric emptying - hence prokinetic agent + considering a non-oral pathway for pain relief)

(NOTE: Aspirin 300mg is just as good in some people as triptan)

Question 5

What is the prophylactic treatment pathway for migraines?

Answer 5

• First line - Propanolol or Topiramate
• Second line - Gabapentin
• Third line - A course of up to 10 sessions of acupunture over 5-8 weeks.

Question 6

In a young person (12-17 years) do you use an oral or nasal triptan?

Answer 6

Nasal sumatriptan.

(NOTE: Though it is MUCH MORE EXPENSIVE!!)

Question 7

When should prophylactic medication be given?

Answer 7

When the patient is experiencing 2 or more attacks per month.

(It is effective in about 60% of patients)

Question 8

What is the mini-prophylaxis treatment for menstrual migraines as recommended by NICE?

Answer 8

A mini-prophylaxis of either:

1. Frovatriptan 2.5mg twice daily
2. Zolmitriptan 2.5mg twice or three times daily.

Question 9

What do SIGN 2008 recommend as treatment for menstrual migraines?

Answer 9

First line - Mefanamic acid

Second line - aspirin+paracetamol+ caffeine.

• Triptans are also useful in the acute situation. (Remember here the NICE mini-prophylaxis advise)

Question 10

What do SIGN 2008 recommend as treatment for migraines in pregnancy?

Answer 10

First line - paracetamol

Second line - Aspirin 300mg or Ibuprofen 400mg in the first and second trimester.

Question 11

If a lady is pregnant, what medication should be used to prophylactically treat migraines?

Answer 11

If pregnant use propanolol. Topiramate is teratogenic

Question 12

Is pizotifen recommended?

Answer 12

Not any longer.

It can cause weight gain and drowsiness.

Question 13

Patients with migraines usually also suffer from what gastrointestinal problem during acute attacks?

Answer 13

Delayed gastric emptying.

Which is why analgesia may not help.

Analgesia will often be prescribed with a prokinetic agent. (e.g. metoclopramide, or prochlorperazine)

Question 14

What is the most common types of aura experience by patients with classical migraine?

Answer 14

Spreading scintillating scotoma + transient hemianopic disturbance

Question 15

How does migraine in children differ from adults?

Answer 15

• Usually doesn’t have aura
• It is shorter-lasting
• Headache is more commonly bilateral
• GI distrubances are more prominent