Management of migraine which has one of the very common presentation as chronic headache

1. Management of Migraine
Presented by: Anish Dhakal (Aryan)

2. Migraine
• Is a commonest cause of episodic headache
• Prevalence rate in-
male-5-10%
female-15to 20%
• 90%of cases onset before the 40 years of age

3. Risk factors
• Genetic cause
• Dietary precipitant
Cheese ,red wine ,chocolate, skipping of meal
• Psychological stress
• Sleep(too little and too much)
• Bright light and loud sound stormy weather
• Physical exertion

4. Clinical feature
1.Migraine without aura
• Paroxysmal headache without vomiting but no
aura
• Scalp may be tender during episodes
• preferences is to in dark and quit environment

5. 2.Migraine with aura
• Paroxysmal headache nausea vomiting and
aura of focal neurological event (visual-zikzag
line)
• Other positive sensory symptoms are tingling,
dysphagia, rarely loss of motor function

6. 3.Migraines related dizziness
• Vertigo remain after migraines attack
• It is overlap with basilar migraines
• Associated with brainstem aura type
• Before and during attack symptoms-
-perioral paresthesia,
- diplopia
-rarely reduce level of consciousness

7. 3.Hemiplegic migraines
• Rare
• autosomal dominant disorder
• hemiparesis, headache, come
• Recovery with in 24 hours

8. Diagnostic criteria
Headache lasting 4 hours to 3 days(if untreated)
1. at least two of
• Unilateral pain(may become
holocranial later in attack)
• Throbbing type pain
• Moderate to severe in
intensity
• Motion sensitivity
(headache made worse with
head movement or physical
activity)
2. at least one of
• Nausea/vomiting
• Photophobia/phonophobia
• no other cause of headache

9. Management
1.Non -pharmacological
• Explanation
• Avoidance of trigger factors and lifestyle
modification

10. 2.Pharmacological
a. Acute attack :
-aspirin(900mg)
-paracetamol 1gm Analgesics
-naproxen 250-500mg
• Pt. should aware that repeated use of analgesics leads
to further headaches
• If necessary metoclopramide and domperidone also
given

11. • Long term use of codeine-containing analgesics
should be avoided
• In severe attack -5 HT agonist (sumatriptan – 25-
100mg/d PO or 6mg SC and should not exceed
200mg/day )
potent vasoconstrictors of the extracranial arteries
• Is C/I in vascular disease

12. b. Migraine suppression medication
• If migraine episodes frequent >1-2/month
• Impacting the quality of life
• Drugs are – valporate 800mg / topiramide
100-200mg
• -propanolol 80-160 mg/day
• -amitriptyline 10mg increasing
weekly in 10mg steps to 50-60mg

13. • Bolulinum toxin -given for chronic migraine
• -31 injection over the scalps
and neck repeated every 3 month.

14. References
• Davidson’s Principle and Practice of
Medicine, 22nd edition
• Kumar and Clark, clinical medicine, 8th
edition

15. THANK YOU