Migraines and headaches

Question 1

What is classed as episodic migraines and chronic migraines?

Answer 1

Episodic: < 15 days/month
Chronic: > 15 days/month

Question 2

What are the symptoms of migraines?

Answer 2

• Throbbing pain 1 side
• N+V
• Sensitivity to light or sound

Aura
- Visual: flickering lights, zigzag, blind spots
- Sensory: numbness, tingling
- Dizzy, off balance
- Dysphasia

Question 3

What drugs are used for migraines?

Answer 3

5-HT1 receptor agonist: Sumatriptan

Oral analgesic
- Paracetamol
- Aspirin
- Ibuprofen
- Tolpenamic acid (acute migraine attack)
- Mefenamic acid (menstrual migraine)

Anti-emetics
- Domperidone
- Metoclopramide

Betablocker: Propranolol

Question 4

What is the treatment for acute attacks (max 2 days a week)?

Answer 4

First line:
- Aspirin/ibuprofen (Soluble and dispersible better absorbed) OR
- 5 HT1 receptor agonist

Second line:
- Sumatriptan AND naproxen

Nausea + vomiting: metoclopramide or domperidone

Question 5

What is used to prevent migraines?

Answer 5

First line: Propranolol
- If unsuitable: atenolol, bisoprolol, metoprolol, nadolol, timolol

If unsuitable: topiramate

Question 6

What is the mechanism of action of 5-HT1 receptor agonists (triptans)?

Answer 6

acts on 5-HT receptors; cranial vasoconstriction

Question 7

How do you take 5-HT1 receptor agonists (triptans)?

Answer 7

One dose ASAP after onset, second dose 2H later

4H if naratriptan, don’t take second dose for same attack

Question 8

What are the side effects of 5-HT1 receptor agonists (triptans)?

Answer 8

Coronary vasoconstriction
- Counsel: stop if heat, tightness in chest or throat
- CI: angina, MIA, stroke, TIA, mod-severe or uncontrolled HT

Question 9

What are the interactions of 5-HT1 receptor agonists (triptans)?

Answer 9

Serotonergic drugs → Serotonin syndrome
- Antidepressants, methadone, tramadol, St John’s Wort, sumatriptan