Migraine

Question 1

Migraine Definition

Answer 1

• Recurrent attacks that last 4-72hours
• Typically one-sided
• Pulsating
• Moderate to severe intensity
• Associated with nausea, photophobia, phonophobia, osmophobia.
• Can occur with or without aura.
• Possible aura symptoms
  
  • Can affect vision, senses, speech, languague, motor function, brainstem, retina.

Question 2

Pharmacological Management of migraine in children

Answer 2

Analgesia
- Ibuprofen 5-10mg/kg Max 400mg PO Q6H PRN
- 2nd - Paracetamol 15mg/kg Max 1g PO Q4H PRN

Avoid Aspirin due to possibility of Reyes Syndrome.

Triptans - Use if Child >= 6yo and above analgesics ineffective
- Sumatriptan 10-20mg Intranasally. Can repeat after 2 hours max 2x per day.
- Rizatriptan 5-10mg PO. Can repeat after 2 hours.

Note: Avoid use of NSAIDS 15+x or Triptans 8+x per month to avoid medication overuse headaches.

No migraine prophylaxis recommended in childhood unless specialist prescribed. Consider if more than 3-4 severe migraines per month.

Nausea
- Ondansetron 0.1-0.15mg/kg PO PRN

Avoid metoclopramide and prochlorperazine for nausea due to dystonia or sedation.

Question 3

Non-pharmacological management of migraine

Answer 3

• Keep a symptom diary.
• Regular sleep schedule
• 1.5 - 2L water per day
• Limit caffeine to 1-2 drinks per day
• Regular exercise - 30 mins per day 4x per week
• Good workplace ergonomics with regular short breaks
• Regular use of relaxation techniques (meditation, mindfulness, yoga, breathing techniques) especially if stress was a trigger.
• Avoidance of known triggers (Alcohol, MSG, citrus, chocolate, preserved meat, perfume)