Migraines

Question 1

What are the main triggers of migraines? (9)

Answer 1

CHOCOLATE

Chocolate
Hangovers
Orgasms
Cheese/caffeine
Oral contraceptives
Lie-ins
Alcohol
Travel
Exercise

Question 2

What are the 5 stages of a migraine?

Answer 2

• Premonitory or prodromal stage (can begin several days before the headache)
• Aura (lasting up to 60 minutes)
• Headache stage (lasts 4 to 72 hours)
• Resolution stage (the headache may fade away or be relieved abruptly by vomiting or sleeping)
• Postdromal or recovery phase

Question 3

What are some typical features of a migraine? (8)

Answer 3

• Usually unilateral but can be bilateral
• Moderate-severe intensity
• Pounding or throbbing in nature
• Photophobia (discomfort with lights)
• Phonophobia (discomfort with loud noises)
• Osmophobia (discomfort with strong smells)
• Aura (visual changes)
• Nausea and vomiting

Question 4

What is an aura associated with a migraine?

Answer 4

Aura can affect vision, sensation or language. Visual symptoms are the most common. These may be:
• Sparks in the vision
• Blurred vision
• Lines across the vision
• Loss of visual fields (e.g., scotoma)

Sensation changes may include tingling or numbness. Language symptoms include dysphasia (difficulty speaking).

Question 5

What is the main feature of a Hemiplegic migraine?

Answer 5

Hemiplegia (unilateral limb weakness)

Question 6

What type of genetic condition is familial Hemiplegic migraines? E.g. dominant

Answer 6

Autosomal dominant

Question 7

What type of migraine can mimic a stoke?

Answer 7

Hemiplegic migraine

Question 8

What are some medical options of an acute migraine attack?(4)

Answer 8

• NSAIDs (e.g., ibuprofen or naproxen)
• Paracetamol
• Triptans (e.g., sumatriptan)
• Antiemetics if vomiting occurs (e.g., metoclopramide or prochlorperazine)

Question 9

Which drugs are contraindicated with migraines? (2)

Answer 9

Oral contraceptives (risk of stroke)
Opioids (make condition worse)

Question 10

What is the mechanism of Triptans?

Answer 10

5-HT receptor agonist - stimulate serotonin

Question 11

What is the maximum amount of triptans that can be taken to halt a migraine?

Answer 11

1 dose
Should never take more than 1 dose in the same attack

Question 12

What are some prophylactic medications used for migraines? (3)

Answer 12

• Propranolol (a non-selective beta blocker)
• Amitriptyline (a tricyclic antidepressant)
• Topiramate (teratogenic and very effective contraception is needed)

Question 13

What is a medical management for men’s trial migraines?

Answer 13

Prophylactic triptans

Question 14

When do menstrual migraines occur?

Answer 14

2 days before start and 3 days after start of menstruation