Migraine Flashcards
Define
severe episodic headache that may have a prodrome of focal neurological symptoms (aura) and is associated with systemic disturbance.
Can be classified as:
- Migraine with aura (classical migraine)
- Migraine without aura (common migraine)
- Migraine variants (e.g. familial hemiplegic, ophthalmoplegic)
Causes
- Poorly understood
- Early aura of cortical spreading depression is associated with intracranial vasoconstriction leading to localised ischaemia
- This is then followed by meningeal and extracranial vasodilation mediated by serotonin, bradykinin and the trigeminovascular system
Epidemiology
Prevalence:
- Males - 6%
- Females - 15-20%
Usually occurs in adolescence and early adulthood
Symptoms
Headache
- Pulsatile
- Duration 4-72 hrs
- Episodic
- NOTE: chronic daily headaches lasting weeks would suggest a different aetiology
Associated Symptoms
- Nausea
- Vomiting
- Photophobia/Phonophobia
- Aura:
- Flashing lights
- Spots
- Blurring
- Zigzag lines
- Blind spots (scotomas)
- Tingling/numbness in the limbs
Triggers and Risk Factors
- Stress
- Exercise
- Lack of sleep
- Oral contraceptive pill
- Foods (e.g. caffeine, alcohol, cheese, chocolate)
Signs
NO specific physical findings
Exclude secondary causes with MMSE, neurological examination, fundoscopy etc.
Investigations
Diagnosis is usually based on HISTORY
Investigations may be useful for excluding other diagnoses
Bloods, CT/MRI, lumbar puncture
Management
NOTE: analgesia overuse can cause headaches
ACUTE
- NSAIDs
- Paracetamol
- Codeine
- Antiemetics
- Triptans (5-HT agonists) - e.g. sumatriptan
Prophylaxis
- b-blockers
- Amitriptyline
- Topiramate
- Sodium valproate
- Menstrual migraines can be controlled with the oral contraceptive pill
Advice
- Avoid triggers
- Rest in a quiet dark room during episodes
Complications
Disruption of daily activities
Can lead to analgesia-overuse headaches in people who use analgesia regularly
Prognosis
Usually CHRONIC
Most cases can be managed well with preventative/early treatment measures
