- >5 attacks a day
- lasting 4 hours to 3 days
- 2 or more features: Unilateral, Pulsating, Moderate/severe intensity, Aggravated or causing avoidance of routine physical activity
- 1 of either Nausea and vomiting or sensitivity to light (photophobia) and sound (phonophobia)
The precise diagnostic criteria can be found here for details: International Headache Society
Treatment:
- Avoid and control triggers; e.g. foods containing tyramine (cheese, chocolate, wine),
- Mild-moderate: paracetomol, NSAIDS,
- Moderate-severe: Triptans (NO OPIATES!)
- Refractory: try combinations Triptans + NSAIDS
- Prophylaxis if more than 3 episodes a month, if it interferes with daily life or acute treatment is ineffective: AEDs, BBs, CCBs, Triptans,
Some migraines have a characteristic 'Aura' before. Typically visual symptoms, a brilliant scintillating scotoma, lasting between 5-60 minutes.
There are also many different types of Migraine, some worth noting;
Basilar type Migraine: accompanying brainstem symptoms e.g. dysarthria, vertigo, diplopia, ataxia.
Familial hemiplegic Migraine: aura of fully reversible motor weakness, aura lasts unusually long 5 mins to 24 hours, pt has at least one affected relative.
Chronic Migraine: Migraine for greater than 15 days a month, for at least three months. Basically a migraine every other day, very disturbing.
WTF if a Triptan?
5-HT1B/1D receptor agonist, causes constriction of cranial blood vessels and inhibits production of inflammatory neuropeptides. Side effects include: Serotonin syndrome and coronary spasm. also used to altitude sickness.
#Migraine #Neurology #FOAMed #MedED
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