Migraines

Question 1

What is the definition of a migraine?

Answer 1

recurrent headache with visual and GI disturbance

Question 2

What percentage of headache patients present with a migraine?

Answer 2

20%

Question 3

Which sex is it more common in?

Answer 3

Female

Question 4

What are the two clinical entities of migraine ?

Answer 4

Chronic

Episodic

Question 5

When is the typical onset of migraines?

Answer 5

Before the age of 40

Question 6

What is the pathogenesis of migraines?

Answer 6

Blood flow changes in the brainstem lead to unstable trigeminal nukes and nuclei in the basal thalamus, which results in vasoactive neuropeptides (including substance P and calcitonin-related peptide) and causes neurogenic inflammation through vasodilation and plasma protein extravasation

Question 7

How is chronic migraine characterised?

Answer 7

by 15 or more headache days per month

Question 8

How is episodic migraine characterised?

Answer 8

by those with migraine who have 0 to 14 headache days per month

Question 9

What are the three types of migraine?

Answer 9

• Migraine with aura (classic migraine)
• Migraine without aura (common migraine)
• Migraine variants (unilateral motor and sensory symptoms resembling stroke)

Question 10

What are precipitating factors for a migraine?

Answer 10

• chocolate
• cheese
• too much/too little sleep
• irritating lights
• alcohol
• hangovers
• exercise

Question 11

What are the main symptoms of a migraine?

Answer 11

• Visual or other aura
• Unilateral, throbbing headache
• Nausea +/- vomiting
• photophobia
• photophobia

Question 12

How is aura described (visual)?

Answer 12

Zig-zag lines, flashing lights

Question 13

What is the diagnostic criteria for migraine without aura?

Answer 13

• attacks lasting 4-72 hours
• Two of the following: unilateral, pulsing, moderate/severe, aggravated by exercise
• During headache experience at least one of: nausea, vomiting, photophobia, phonophobia
• not attributed to another disorder

Question 14

What is the first line treatment for migraines that are not severe?

Answer 14

NSAIDs - (good as there is less chances developing a medication misuse headache)
paracetamol

Question 15

What treatment is recommended and prescribed in more severe migraines?

Answer 15

Triptans

Question 16

What classification of medication are triptans?

Answer 16

Oral 5HT (serotonin) agonists

Question 17

What is an example of a triptan?

Answer 17

Sumatriptan, Zolmitriptan, Rizatriptan

Question 18

What else may be prescribed for migraine attacks?

Answer 18

Antiemetics e.g. metaclopramide

Question 19

What are general measures that can help with migraines?

Answer 19

Warm or cold packs to the head
rebreathing into a paper bag
stop COCP

Question 20

What are prophylactic medications to prevent migraines?

Answer 20

- Beta-blockers e.g. propanolol (first line)
Valproate
Pizotifen
Gabapentin
Pregabalin