5. Headache has at least two of the following
characteristics :
* Unilateral location .
* Pulsating quality ( varying with heartbeat )
* Moderate or severe pain intensity .
* Aggravation by or causing avoidance of
routine physical activity e.g walking or
climbing stairs .
6. During headache at least one of the
following :
* Nausea and / or vomiting .
* Photophobia and phonophobia .
7. Not attributed to another disorder ( history
& examination do not suggest a secondary
headache disorder ) .
8. Attacks may be shorter lasting .
Headache is more commonly bilateral .
Gastrointestinal disturbance is more
prominent .
9. A typical aura may occur hours prior to the
headache .
Include a transient hemianopic disturbance
, spreading scintilling scotoma & sensory
symptoms may also occur .
10. Is one which results in hemi sensory or
hemi motor finding associated with a typical
migraine presentation .
It is like TIA but the pt. is Young age & has
past medical history for migraines .
12. Acute : ( Triptan + NSAID ) or ( Triptan +
Paracetamol ) .
Young People aged 12-17 Years consider a
nasal triptan in perference to an oral
triptan.
13. If the above measures are not effective or
not tolerated offer a non-oral preparation
of metoclopramide or prochlorperazine &
consider adding a non-oral NSAID or
Triptan .
15. Prophylaxis should be given if pts. are
experiencing > or = 2 attacks per month .
Nice advice either Topiramate or
propranolol according to person’s
preference , comorbidities & risk of adverse
events .
16. Propranolol should be used in preference to
topiramate in women of child bearing age
as it may be teratogenic & it can reduce the
effectiveness of hormonal contraceptives .
17. If these measures fail NICE recommend a
course of up to 10 sessions of acupuncture
over 5-8 weeks or gabapentin .
18. NICE recommend : Advise people with
migraine that riboflavin ( 400 mg once a
day ) may be effective in reducing migraine
frequency & intensity for some people .
19. For women with predictable menstrual
migraine treatment NICE recommend either
frovatriptan or zolmitriptan as a type of
mini-prophylaxis .
20. Paracetamol 1g is first-line .
Aspirin 300 mg or Ibuprofen 400 mg can be
used second-line in the first & second
trimester .
21. Frequency & severity of migraines increase
around the time of menstruation .
SIGN recommends that women are treated
with mefanamic acid or a combination of
aspirin , paracetamol & caffeine .
22. Triptans are also recommended in the acute
situation .
NICE recommend either frovatriptan or
zolmitriptan as a type of mini-prophylaxis .
23. If pts. Have migraine with aura then the
COC is absolutely CI due to an increased
risk of stroke .
Ergot derived compounds & Triptans are CI
for treatment of hemiplegic migraine
because of the risk of precipitating a stroke.
24. Safe to prescribe Hormone replacement
therapy for pts. With a history of migraine
but it may make migraines worse .
26. Pain typical occurs once or twice a day .
Episode lasting 15 minutes – 2 hours .
Clusters typically last 4 – 12 weeks .
27. Intense pain around one eye ( recurrent
attacks always affect same side ) .
Accompained by eye redness , lacrimation &
lid swelling .
Miosis & Ptosis in a minority .
28. Nasal stuffiness , Rhinorrhoea .
Pt. is restless during an attack .
Examination between the attacks should be
normal .
31. Consider specialist referral .
Sumatriptan associated with chest pain
possibly due to vasospasm & also ass. With
MI so contraindicated in pts. With known
IHD .
32. It is one of the most common causes of
chronic daily headache .
33. Present for > 15 days per month .
Developed or worsened while taking regular
symptomatic medication .
34. Pts. Using opioids & Triptans are at most
risk .
May be Psychiatric co-morbidity .
38. A unilateral disorder characterised by brief
electric shock-like pains , abrupt in onset &
termination , limited to one or more
divisions of the trigeminal nerve .
39. The pain is commonly evoked by light touch
including washing , shaving , smoking ,
talking & brushing the teeth ( trigger factors
) & frequently occurs spontaneously .
40. Small areas in the nasolabial fold or chin
may be particularly susceptible to the
precipitation of pain ( trigger areas ) .
The pain usually remit for variable periods .
41. Majority of cases are idiopathic .
Compression of the trigeminal roots by
tumours or vascular problems may occur .
42. Carbamazepine is first line .
Failure to respond to treatment or atypical
features ( e.g < 50 Years old ) should
prompt referral to neurology .
43. Sudden enlargement of pituitary tumour
secondary to haemorrhage or infarction .
45. Visual field defects .
Extra ocular nerve palsies with third nerve
palsy the commonest finding .
Features of pituitary insufficiency e.g
Hypotension secondary to hypoadrenalism .
48. Avoid aspirin in children < 16 Years as risk of
Reye’s Syndrome .
Codeine would also be a poor choice as it has
limited benefit in migraine .
49. Pts. With migraine experience delayed gastric
emptying during acute attacks so decrease effect of
analgesics , for this reason analgesics are often
combined prokinetic agents as metoclopramide .
