Migraine
- Recurring, unilateral throbbing headache
- Generally lasts hours to days
- Can be accompanied by;
- Gastrointestinal upsets
- Photophobia
- Phonophobia
- 20% get a proceeding aura
- Around 10-20% have migraine
- More common in women
- Patient may be worried it is something more sinister
Signs and symptoms
Prodrome phase
- Occurs hours or days before headache
- Altered mood
- Irritability
- Depression
- Fatigue
- Cravings
- Stiff muscles
Aura phase
- Immediately precedes headache
- Lasts 5-20 mins
- Symptoms can be visual, motor or sensory
- Visual – flashing lights, blurring, zig zag lines (fortifications)
- Sensory – numbness and tingling
- Motor – speech disturbances
Pain phase
- Unilateral, throbbing
- Gradual onset
- Associated with;
- Nausea
- Photophobia
- Phonophobia
- Osmophobia
- Impaired mood, concentration and light-headedness
Postdrome phase
- Tired, irritable, malaise
Pathophysiology
- Depressed neurological activity over an area of cortex (decreased serotonin)
- Release of inflammatory mediators, which irritate cranial nerve roots
- Dilation followed by constriction of blood vessels
- Can be a symptom of hypothyroid
Triggers
- Foods – often those containing tyramine
- Menstrual cycle
- Alcohol, caffeine
- Bright lights
- Sleep disturbance
- Medications e.g. OCP, sleeping tables
- Ask patient to keep a headache diary
Management
- Treatment focuses on three areas,
- Avoidance of triggers
- Control of symptoms
- Analgesics and NSAIDs
- Sumatryptin
- Ergot alkoids
- Antiemetics
- Prevention
- Beta-blockers
- Anticonvulsants – valproate, topiramate (teratogenic)
- Antidepressants – amytryptilline, fluoxetine