Neurology - migraine

Question 1

How long do migraines last?

Answer 1

4-72h

Question 2

Typical features of migraine

Answer 2

Moderate to severe intensity

Pounding or throbbing in nature

Usually unilateral but can be bilateral

Photophobia

Phonophobia

Nausea and vomiting

May have aura

Question 3

What is a hemiplegic migraine?

Answer 3

Symptoms of a hemiplegic migraine can vary significantly. They can include:

• Typical migraine symptoms
• Sudden or gradual onset
• Hemiplegia (unilateral -weakness of the limbs)
• Ataxia
• Changes in consciousness

These can mimic stroke so it is important to urgently exclude a stroke in patients presenting with symptoms of hemiplegic migraine

Question 4

Triggers for migraine include

Answer 4

Stress

Certain foods e.g. chocolate, cheese and caffeine

Dehydration

Menstruation

Abnormal sleep patterns/lack of sleep

Bright lights

Question 5

Acute management options for migraine

Answer 5

Helps to stay in the dark, stay well hydrated and lie down

Paracetamol

Triptans (e.g. sumatriptan 50mg as the migraine starts)

NSAIDs (e.g ibuprofen or naproxen)

Antiemetics if vomiting occurs (e.g. metoclopramide)

Question 6

What are triptans?

Answer 6

5HT receptor agonists (serotonin receptor agonists)

They act on:

• Smooth muscle in arteries to cause vasoconstriction
• Peripheral pain receptors to inhibit activation of pain receptors
• Reduce neuronal activity in the central nervous system

Question 7

Prophylaxis of migraine

Answer 7

Trigger identification and avoidance using headache diary

Propranolol
Topiramate
Amitriptyline

Also some people find acupuncture effective