migraines Flashcards
What are migraines?
complex neurological condition that cause headache and other associated symptoms
occur in attacks that follow typical pattern
types of migraines
migraine without aura
migraine with aura
silent migraine
hemiplegic migraine
how long do they last?
4-72 hours
typical symptoms
mod-severe pounding or throbbing unilateral photophobia phonophobia aura nausea and vomiting
aura
visual changes
sparks, blurring, lines, loss of visual fields
what can hemiplegic migraines mimic?
stroke
symptoms of hemiplegic migraine?
unilateral weakness of limbs ataxia change in counsciousness sudden or gradual onset typical migraine symptoms
triggers
stress bright lights strong smells foods eg chocolate dehydration menstruation sleep
prodromal stage
can involve several days of subtle symptoms eg yawn, fatigue, mood change
5 stages of migraine
prodromal aura - 60mins headache resolution postdromal
acute management
dark quiet room and sleeo paracetamol triptans NSAIDs antiemetics
class of drug - triptans
5HT receptor antagonist
triptan name and dose
sumitriptan 50mg as migraine starts
3 actions of triptans
smooth muscle vasoconstriction
inhibit peripheral pain receptors
reduce neuronal activity in CNS
long term treatment - migraine prevention
propanolol
topiramate
amitryptiline
topiramate - what to be aware of
teratogenic
cleft lip/palate
migraine prophylaxis
acupuncture
vitamin B2 - riboflavin
NSAIDs or triptans
what can be helpful to identify triggers?
keeping a headache diary
Headache red flags
age over 50 thunderclap headache/acute onset neurological symptoms or signs stiff neck +/- fever worse with valsalva manoeuvre/movement new or worsening headache
statistics
6 million people UK
10% men and 22% women
age 20-50
chronic migraine
headache >15 days per month and atleast 8 are migraine for more than 3 months
