What is a migraine defined by? How long does it usually last? And what is it enough to do?
Unilateral, pulsating pain may be severe It occurs more commonly in females than males and characterised by recurrent attacks 4-72 hours. Enough to affect daily activities can cause nausea and vomiting, photophobia
What are some migraine categories with regards to Auras?
Migraines characterised into with or without Aura and are either chronic or episodic
What are a few migraine onsets? An aura can be either x or y??? And when do they come about??
- Migraines can come with Auras (visual or sensory)
- Usually precede onset of the migraine - visuals (zig zag or flickering lights/ spots)
- Sensory - pins and needles/ numbness
- Dysphasia is also a sign
Take medication as soon as patient knows they’re developing a migraine and taken at the start of the headache not the aura
What is the difference between episodic and chronic headaches? - in terms of the number of days that they last??
Episodic- headache less than 15 days per month and low frequency. Chronic - lasts at least 15 days per month.
Women migraines can be caused by….
Some women experience a drop in oestrogen levels just before menstruation as a trigger - generally occurring two - three days before the start of bleeding up until 3 days after
What is the aim of migraine treatment?
preventative, reduce the frequency of attacks, severity and duration
How does lifestyle effect migraines? And what are some other triggers
Eating regular meals,adequate hydration, sleep and exercise. Other triggers - stress,relaxation, foods and drink and bright light
Treatment for migraines is guided by …. But excess use of medication can ultimately lead to what?
- Treatment guided by response to previous treatment and severity of attacks
- Aspirin, paracetamol(Soluble) fastest onset of action
- Offer 5HT1 receptor agonist(Triptans) if above meds are inadequate
- Antiemetics may be required for nausea and vomiting
Excess use of migraine medications can cause overuse headaches
Analgesics which NSAIDs ( something acid) is licensed in migraines? What other NSAID are also licensed
- Most migraines respond to aspirin and paracetamol
- Solvable preps are preferred because they improve solubility and therefore absorption
- Tofenamic acid - licensed specifically for migraines
- Other NSAIDs (diclofenac potassium, flurbiprofen and ibuprofen also licensed)
5HT Receptor agonists= when are they used, what are they not indicated in? What are examples? If a patient doesn’t respond? Nara vs Triptan? When would we use subcutaneous?
- Act on the 5HT (Serotonin receptors)
- Preferred treatment for those who fail to respond to conventional analgesics
- Not indicated for treatment of hemiplegic,basilar or opthalmoplegic migraines)
- Examples for migraines: almotriptan,eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan and zolmitriptan.
- If patient doesn’t respond to one - the other can be tried
- Subcutaneous Sumatriptan and nasal zolmitriptan can be given to patients who present with early vomiting or who have severe attacks
- Sumatriptan and zolmitriptan are also used to treat cluster headaches
- Triptans can be repeated after 2 hours but only if a response is seen but not fully adequate. If no response is seen don’t re use
- Naratriptan - we can wait 4 hours
Other NSAIDs that can be used include…. And what is unlicensed but still an option??? When could we give suppositories when is mefanamic acid given
Naproxen ,tolfenamic acid,diclofenac potassium, unlicensed but may be an option to use diclofenac suppositories in patients that are vomiting.Mefanamic acid - period migraines and already using it for dysmenorrhea and menorrhagia
Mono therapy - patients who respond to mono therapy can use…
- for patients that have had two triptan receptor failures and failed response to nsaids can try????
Patients that respond to mono therapy can use naproxen and sumatriptan together
For patients that have had two 5HT1-Receptor agonist failures and failed to respond to nsaids can try rimegepant
