What are migraines
complex neurological condition causing episodes/ attacks of headaches and associated symptoms
What are the four types of migraine
- migraine without aura
- migraine with aura
- silent migraine (aura but no headache)
- hemiplegic migraines
What are the 5 stages of migraine?
- prodrome
- aura
- headache
- resolution stage
- postdromal or recovery stage
What are the typical features of a migraine?
- usually unilateral
- moderate- severe intensity
- pounding/ throbbing
- photo/ phonophobia
- osmophobia (strong smells)
- aura
- nausea and vomiting
What can aura affect
- vision
- language
- sensation
How does aura affect vision
- sparks
- blurred vision
- lines across vision
- loss of visual fields
How does aura affect sensation
tingling or numbness
How does aura affect language
dysphasia
What is the main feature of hemiplegic migraines
unilateral limb weakness (hemiplegia) therefore mimics stroke/ TIA
What are two other features of hemiplegic migraines
- ataxia- loss of coordination
- impaired consciousness
What is the genetics of hemiplegic migraines
autosomal dominant
What are common triggers of migraines
- stress
- bright light
- strong smells
- certain foods (chocolate, cheese, caffeine)
- dehydration
- menstruation
- disrupted sleep
- trauma
What is non medical acute management of migraines
patients often develop strategies eg sleeping in a dark, quiet room
Medicines for an acute migraine attack
- NSAIDs
- paracetamol
- triptans (eg sumatriptans)
- antiemetics
opiates NOT used- may make it worse
What are triptans used for in migraines
to abort migraine attacks when they start to develop
What type of drug are triptans
5- HT receptor agonists- bind to stimulate serotonin receptors
Whats the mechanism of action of triptans
- cranial vasoconstriction
- inhibit transmission of pain signals
- inhibiting release of inflammatory neuropeptides
Contraindications of triptans
related to vasoconstriction
- HTN
- coronary artery disease
- stroke
- TIA
- MI
Non medical migraine prophylaxis
headache diary and avoiding triggers
Medical migraine prophylaxis
- propanolol ( non selective beta blocker CI in asthma)
- amitriptyline (tricyclic antidepressant)
- topiramate (teratogenic and very effective contraception required)
