migraines

Question 1

What are migraines?

Answer 1

complex neurological condition that cause headache and other associated symptoms
occur in attacks that follow typical pattern

Question 2

types of migraines

Answer 2

migraine without aura
migraine with aura
silent migraine
hemiplegic migraine

Question 3

how long do they last?

Answer 3

4-72 hours

Question 4

typical symptoms

Answer 4

mod-severe
pounding or throbbing
unilateral
photophobia
phonophobia
aura
nausea and vomiting

Question 5

aura

Answer 5

visual changes

sparks, blurring, lines, loss of visual fields

Question 6

what can hemiplegic migraines mimic?

Answer 6

stroke

Question 7

symptoms of hemiplegic migraine?

Answer 7

unilateral weakness of limbs
ataxia 
change in counsciousness 
sudden or gradual onset
typical migraine symptoms

Question 8

triggers

Answer 8

stress
bright lights 
strong smells 
foods eg chocolate
dehydration 
menstruation 
sleep

Question 9

prodromal stage

Answer 9

can involve several days of subtle symptoms eg yawn, fatigue, mood change

Question 10

5 stages of migraine

Answer 10

prodromal 
aura - 60mins
headache 
resolution 
postdromal

Question 11

acute management

Answer 11

dark quiet room and sleeo
paracetamol
triptans 
NSAIDs
antiemetics

Question 12

class of drug - triptans

Answer 12

5HT receptor antagonist

Question 13

triptan name and dose

Answer 13

sumitriptan 50mg as migraine starts

Question 14

3 actions of triptans

Answer 14

smooth muscle vasoconstriction
inhibit peripheral pain receptors
reduce neuronal activity in CNS

Question 15

long term treatment - migraine prevention

Answer 15

propanolol
topiramate
amitryptiline

Question 16

topiramate - what to be aware of

Answer 16

teratogenic

cleft lip/palate

Question 17

migraine prophylaxis

Answer 17

acupuncture
vitamin B2 - riboflavin
NSAIDs or triptans

Question 18

what can be helpful to identify triggers?

Answer 18

keeping a headache diary

Question 19

Headache red flags

Answer 19

age over 50 
thunderclap headache/acute onset 
neurological symptoms or signs 
stiff neck +/- fever 
worse with valsalva manoeuvre/movement
new or worsening headache

Question 20

statistics

Answer 20

6 million people UK
10% men and 22% women
age 20-50

Question 21

chronic migraine

Answer 21

headache >15 days per month and atleast 8 are migraine for more than 3 months