Migraines

Question 1

Migraines without aura

Answer 1

• at least 5 attacks
• lasting 4-72hrs
• unilateral, pulsating quality, aggravation by routine activity

Question 2

Migraines with aura

Answer 2

at least two attacks
at least one fully reversible aura
no aura lasting more than 60 minutes
headaches follows aura within 60min
aura symptoms: visual, sensory, speech/language, motor brainstem, retinal

Question 3

Migraine triggers

Answer 3

medication overuse headache
oral contraceptives, hydralazine, nitroglycerin, nifedipine, cocaine
chocolate, oranges, tomatoes, onions, aged cheese, processed meats
aspartame and monosodium glutamate
alttitude/weather changes

Question 4

Abortive treatment

Answer 4

educate to avoid medication overuse
mild-moderate: NSAIDs, acetaminophen
Moderate-severe: triptans/ergots

Question 5

Preventive treatment

Answer 5

four or more attacks per month with disability at least 3 days/month

Question 6

Abortive treatment Stepwise treatment

Answer 6

FIRST
Triptans, NSAIDS
SECOND
NSAIDS
THIRD
- failure to respond to at least 2 triptans

Question 7

Preventive treatment Stepwise

Answer 7

FIRST
Valproate, topiramate, metoprolol, propranolol, frovatriptan
SECOND
amitriptyline
THIRD
- lisinopril, clonidine, guanfacine, carbamazepine

Question 8

Non-pharm therapy

Answer 8

Sleep, diet, exercise, massage, headache diary, avoid triggers

Question 9

Triptans overview

Answer 9

Contraindications: recent use of an ergot or other triptan, MAO-A inhibitor use in the last week, ischemic heart disease, angina, history of stroke or TIA or hemiplegic/basilar migraine. arrhythmia