Migrane Flashcards
3 types of migraine and two classifications
1) migraine with aura
2) migraine without aura
3) migraine aura without headache
1) episodic
2) chronic
Migraine presentation
Unilateral headache (70% of the time) Premonition and or aura (often visual disturbance) Photophobia Nausea/vomiting Pulsating/throbbing pain
Triggers
CHOCOLATE = 50%
Chocolate Hangovers Orgasm Cheese Oral contraceptive pill Lie ins Alcohol Tumult (lots of people, noise etc) Exercise
In women migraines can be causes by…
Menstruation- a day or two before starting and at no other time = menstrual migraine
Migraine diary useful
Patient has a headache. You take a good history - then what do you do for your examination?
Optic fundi
Blood pressure
Head/neck - scalp, neck muscles, temporal arteries
(Children - head circumference)
Red flags for a brain tumour
Papilloedema New seizure Headache + existing cancer Abnormal neurological signs Change in consciousness, confused, uncoordinated
Red flags for migraine headache
New onset under 10 or over 50
Atypical aura (lasts more than 1hour (usually 15-30mins)
Systemic symptoms (myalgia, fever, weight loss)
Rapid onset - worst ever pain
Confusion, seizures \/GCS
Treatment of migraine
- patient to keep a diary of triggers and attacks
1) aspirin or ibruprofen (+prochlorperazine if nausea and vomiting)
2) rectal diclofenac (+rectal domperidone for nausea)
3) triptans (ie sumatriptan)
Prevention of migraine
First line
Propranolol or amitriptyline
Triptans - how do they work and name some
5HT agonists - constrict cranial arteries. Inhibit release of substance P, blocking trigeminal nerve transmissions (thought it cause migraine)
Almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan
Don’t use if bad HTN, IHD
Take during the headache
