Migraine

Question 1

Clinical features

Answer 1

• unilateral, throbbing headache
• nausea
• photophobia
• aura

Question 2

Is migraine more common in women or men?

Answer 2

Women 3:1 men

Question 3

Common triggers for migraine attack

Answer 3

• tiredness, stress
• alcohol
• COCP
• lack of food or dehydration
• cheese, chocolate, red wines, citrus fruits
• menstruation
• bright lights

Question 4

What is a hemiplegic migraine?

Answer 4

a variant of migraine in which motor weakness is a manifestation of aura in at least some attacks

around half of patients have a strong family history

Question 5

Acute management

Answer 5

triptan + NSAID
triptan + paracetamol
young people = nasal triptan

Question 6

Prophylactic Management

Answer 6

propranolol
topiramate (avoid in women of childbearing age)
amitriptyline

Question 7

Prophylactic treatment specifically for women with predictable menstrual migraines

Answer 7

frovatriptan (2.5 mg twice a day)

zolmitriptan (2.5 mg twice or three times a day)

Question 8

Migraine treatment in pregnancy

Answer 8

paracetamol 1g is first-line

NSAIDs can be used second-line in the first and second trimester

avoid aspirin and opioids such as codeine during pregnancy