Why are migraines harmless?
- They don’t inherently threaten health
- They are self-limiting
- The frequency often reduces with age
What is a migraine?
severe throbbing or pulsing headache which is often temporal or retrobulbar. Can often accompanied by nausea & vomiting
What are the two classifications of a migraine?
- migraine with aura
- migraine without aura
What is a retinal migraine?
repeated attacks of monocular visual disturbance including scotoma or blindness, associated with migraine headaches
What are the 4 phases of a migraine with aura?
- prodromal phase
- aura phase
- headache phase
- postdromal phase
What is the migraine prodromal phase?
- They feel a sense of premonition regrading an imminent migrane episode
The migraineur may feel irritable, depressed or abnormally tired and an exhibit sensory hypersensitivity e.g noise and bright lights
What is the migrane aura phase?
Occurs 5-30 mins prior to next stage. Sensory function disturbance can occur and is frequently visible. Can be coloured or described as zigzagging
What is the headache phase of the migraine?
unilateral throbbing behind the eye or temporally. Pain can last 4 hours to several days. Nausea is also a common symptom as well as sensory hypersensitivity
What is the postdromal phase of a migraine?
Person affected can feel abnormally fatigued and emotionally depressed. They can also have a reduced lack of energy for a couple days after the episode
What is the depolarization theory?
Known as the cortical spreading depression. The neurological activity is depressed over an area of the cortex of the brain. This releases inflammatory mediators leading to irritation of the cranial roots
What is the vascular theory?
When the blood vessels in the brain contract and expand. Starts in the occipital lobe. The reduced blood to the occipital lobe triggers the aura
What is the serotonin theory?
A neurotransmitter which helps control mood. Low serotonin levels in the brain lead to constriction and dilation of blood vessels triggering a migraine
What are precipitating factors of a migraine?
caffeine
chocolate
alcohol
MSG
anxiety
psycho-social stress
What are the differential diagnoses for migraine without aura?
- tension
- dehydration
- cluster headache
- drug related or rebound headache
- intracranial disorders
What are the differential diagnoses for migraine with aura?
- TIA
- cerebral embolus
- arterio-venous malformations
- oestrogen-induced cerebrovascular compromise
What are relieving factors for a migraine?
- Caffeine
- OTC meds - co-codamol, ibuprofen
- acupuncture
- physiotherapy
- magnesium, vit B supps and herbal meds
