2 migraine

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2 migraine

  1. 1. INTERNAL MEDICINE<br />
  2. 2. Migraine<br />Def:<br />A migraine headache is a throbbing or pulsating headache that is often one sided (unilateral) and associated with nausea; vomiting; sensitivity to light, sound, and smells; sleep disruption; and depression.<br />
  3. 3. Migraine<br />Aetiology:<br />Exact cause is unknown<br />Heredo-familial 50%<br />Precipitating factors-<br />Alcohol <br />Bright lights <br />Certain odors or perfumes <br />Changes in hormone levels<br />
  4. 4. Migraine<br />Aetiology:<br />Precipitating factors-<br />Changes in sleep patterns<br /> Exercise<br /> Loud noises <br />Missed meals <br />Physical or emotional stress <br />Smoking or exposure to smoke<br />Baked goods <br />Chocolate<br />Foods containing monosodium glutamate (MSG)<br />
  5. 5. Migraine<br />Classifications:<br />1.Classical migraine- visual or sensory symptoms precede or accompany the headache<br />2.Common migraine- no visual and sensory features with headache, nausea and vomiting<br />3.Hemiplegic migraine- prolonged headache lasting or days<br />4.Basilar migraine- Occipital headache proceed by vertigo, diplopia, dysarthria<br />5.Cluster headache- Bouts of severe pain around the one eye with associated epiphora and nasal congestion<br />
  6. 6. Migraine<br />Clinical features:<br />A temporary blind spot<br />Blurred vision<br />Eye pain<br />Seeing stars or zigzag lines<br />Tunnel vision<br />Feel throbbing, pounding, or pulsating<br />Are worse on one side of the head<br />Start as a dull ache and get worse within minutes to hours<br />Last 6 to 48 hours<br />
  7. 7. Migraine<br />Clinical features:<br />Chills<br />Increased urination<br />Fatigue<br />Loss of appetite<br />Nausea and vomiting<br />Numbness, tingling, or weakness<br />Problems concentrating, trouble finding words<br />Sensitivity to light or sound<br />Sweating<br />
  8. 8. Migraine<br />D/D:<br />DNS with frontal or maxillary sinusitis<br />Intracranial tumour(occipital lobe) in early stage<br />
  9. 9. Migraine<br />Investigations:<br />CBC<br />Plain x-ray of skull<br />X-ray PNS O/M view<br />CT<br />
  10. 10. Migraine<br />Management:<br />A.General measures-<br />Reassurence and relief of anxiety<br />Avoidance of precipitating factors such as oral contracetives<br />B.Treatment during acute attacks-<br />Analgesics(paracetamol or aspirin) with antiemetics(dompredone)<br />In severe attacks-<br />Ergotamine tartrate 0.5-1.0 mg sublingually<br />Tab. Sumatriptan 100 mg <br />
  11. 11. Migraine<br />Management:<br />C.Prophylaxis-<br />Propranolol 40-80 mg 8 hrly and pizotifen 1.5-3.0 mg at night<br />Antidepressants such as amitriptyline 25-100 mg at night<br />Methysergide 1-2 mg 8 hrly in resistant case<br />

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