(!) Migraine

Question 1

Migraine adult presentations

Answer 1

Pretty much anyone, early life

Reccurent unilateral headache that impairs day to day activity, throbbing

can present with MANY different sx

4-72h
If last more- Status Migrainus

with
Aura
Sonophobia/photophobia
Worsen with activity
Nausea and vomiting
Neuro sx- diplopia, hearing, tingling, weakness, etc

always ask red flags
worse in morning/pooping/lying down
systemic changes
neck stiffness
sudden onset
confusion
-

Question 2

adult migraines Investigations and treatment

Answer 2

no real Ix, but consider CT if red flags
Or LP if sounds SAH

Mx-
Avoidance of triggers
Exercise, sleep, less stress

Acute- Mild/moderate- Aspirin effective
Severe triptans -nasal, oral, subcut- Sumatriptan can be all 3; Egrotamine
Anti-emetics-metoclopramide, promethazine
IV steroids or MagSulph can be considered

Prophylaxis-
Bblockers in classic–propanolol
Anti-convulsants- Topiomerate, Levitaceram
TCA
CCB- if weakness- verapramil

other solutions-
CBPR antagonist
Botox/botulism toxin

Nerve block