Migraine

Question 1

definition of a migraine?

Answer 1

severe episodic headache that may have a prodrome of focal neurological symptoms (aura) and is associated with systemic disturbance. 
can be classified as: 
migraine with aura 
migraine without aura 
migraine variants

Question 2

what are the common triggers for migraine?

Answer 2

o	Tiredness/stress 
o	Alcohol 
o	COCP
o	Lack of food or water 
o	Cheese, chocolate, red wine, citrus fruits 
o	Menstruation 
o	Bright lights

Question 3

what criteria need to be fulfilled for a diagnosis of migraines?

Answer 3

Headache attacks lasting 4-72 hours* (untreated or unsuccessfully treated)
Headache has at least two of the following characteristics:

• 1. unilateral location*
• 2. pulsating quality (i.e., varying with the heartbeat)
• 3. moderate or severe pain intensity
• 4. aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs)
During headache at least one of the following:

• 1. nausea and/or vomiting*
• 2. photophobia and phonophobia
Not attributed to another disorder (history and examination do not suggest a secondary headache disorder or, if they do, it is ruled out by appropriate investigations or headache attacks do not occur for the first time in close temporal relation to the other disorder)

Question 4

epidemiology of migraines?

Answer 4

• Usually occurs in adolescence and early adulthood more common in women x3
• Usually occurs in adolescence and early adulthood

Question 5

symptoms of a migraine?

Answer 5

o	Unilateral throbbing headache 
o	Nausea 
o	Photophobia 
o	Phonophobia 
o	Duration 4-72 hrs

Question 6

symptoms of an aura?

Answer 6

• Flashing lights
• Spots
• Blurring
• Zigzag lines
• Blind spots (scotomas)
• Tingling/numbness in the limbs

Question 7

investigations for migraine?

Answer 7

• Diagnosis is usually based on HISTORY
• Investigations may be useful for excluding other diagnoses
• Bloods, CT/MRI, lumbar puncture

Question 8

management plan for acute migraines?

Answer 8

o First line: offer combination therapy with oral triptan and NSAID
o Or oral triptan and paracetamol
o Young people: 12-17 offer nasal triptan
o If not effective offer non oral metoclopramide (although be careful with young people)

Question 9

management plan for migraine prophylaxis?

Answer 9

o Needs to be given to patients experiencing 2 or more attacks per month
o Topiramate or propranolol as first line
o Propranolol to be prioritised in women of child bearing age
o Topiramate can be teratogenic
o If these fail acupuncture for 5-8 weeks

Question 10

advice for migraine sufferers?

Answer 10

o Avoid triggers

o Rest in a quiet dark room during episodes

Question 11

what are the complications of a migraine?

Answer 11

• Disruption of daily activities

* Can lead to analgesia-overuse headaches

Question 12

prognosis for patients with a migraine?

Answer 12

• Usually CHRONIC

* Most cases can be managed well with preventative/early treatment measures