Recommended
More Related Content
Similar to Migraine pain and How to handle it in PHC
Similar to Migraine pain and How to handle it in PHC (20)
More from Saugat Chapagain
More from Saugat Chapagain (14)
Recently uploaded
Recently uploaded (20)
Migraine pain and How to handle it in PHC
- 1. Migraine Dr. Muhammad Zubair Chaudhry Medical Officer (G.P.) MoH-52751
- 2. What is Migraine? Headache characterized by: Recurrent attacks of moderate to severe throbbing and pulsating pain On one side of head Often (but not always) accompanied by Nausea Vomiting Extreme sensitivity to light and sound Common form of vascular headache More common in females Usu. Starts in puberty and continues into late middle life Common migraine There is no preceding aura Classical migraine Symptoms of aura precedes headache Include scotomas and visual hallucinations
- 3. Symptoms Headache is recurrent and usu. Unilateral Often a/w nausea + vomiting Interval is variable Lasts for few hours to 2-3 days Maybe relieved with/without medications Often abated by sleep Family history – maybe positive Sometimes a/w motor weakness which usu. Recovers in few hours (hemiplegic migraine)
- 4. Etiology Exact cause unknown Presumed cause Abnormal brain activity temporarily affecting the nerve signals, chemicals and blood vessels in the brain Over 50% cases have a close relative with migraine (genetic connection)
- 5. Precipitator factors Menstruation Flashing lights Anxiety Various foods Chocolate Cheese Coffee
- 6. Progression of symptoms Four stages 1. Prodrome 2. Aura 3. Attack 4. Post-drome
- 7. Signs and investigations Clinical examinations and investigations appear normal
- 8. Differential diagnosis Temporal arteritis Cluster headache Acute glaucoma Meningitis SAH Tension headache Cervical spondylosis
- 9. Pathogenesis Cerebral oligemia Aura cerebral & extracranial hyperemia headache Attacks a/w changes in plasma 5HT (serotonin from tryptophan)
- 10. Triggers Chocolate Cheese Caffeine or its withdrawl Alcohol Anxiety Travel Exercise In over 50% cases, no trigger Upto 10% cases, avoiding triggers helps
- 11. Management Prophylaxis in diagnosed cases If frequency > 2 attacks per month, if one drug doesn’t work after 3 months, try another >65% patients will get decreased frequency of attacks by prophylaxis Treating attacks
- 12. Prophylaxis 1. Pizotifin 0.5 -1 mg / 8Hr – PO Or 1-3 mg PO x HS Is a 5HT antagonist A/e – Drowsy Weight gain Increased effect of alcohol Increased risk of glaucoma 2. Propranolol 40-120mg / 12 Hr – PO 3. Amitriptylene 25-75mg PO x HS A/e – Drowsy Dry mouth Blurred vision
- 13. Prophylaxis – second line Valproate 400-600 mg / 12 Hr Verapamil and SSRI are also used but evidence is not strong Gabapentene and topiramate have shown good results in trials
- 14. Treatment At PHC level by GP Analgesics – Ibuprofen/ PCM Tryptans Antiemetics Lifestyle modifications For severe migraine, advice meditations, relaxation techniques & acupuncture
- 15. Drugs at PHC level Note – low dose might fail as peristalsis is slow Prescribe dispersible high doses OR opt for IV/ IM analgesia
- 16. Non migraine specific drugs Antiemetics Metochlopromide 10-20 mg IV Domperidone 10 mg Analgesics Aspirin (ASA) 500-1000 mg /6Hr PO PCM 1000 mg / 6 Hr PO Ibuprofen 200-800 mg Diclofenac 50-100 mg Opioids Minimal efficiency Most imp indication – IHD
- 17. Migraine specific drugs Ergot Alkaloids Dihydro ergotamine Ergotamine Triptans - 5HT inhibitors Sumatriptan Zolmitriptan Narotriptan Rizatriptan Almotriptan Eletriptan Frovatriptan
- 18. What can aGP advice? Try sleeping or lying down in dark room during attacks Try avoid known triggers Stay well hydrated Limit caffeine and alcohol Maintain weight Eat meals at regular intervals Regular exercise Enough sleep Manage stress
- 19. Thank you Have a headache free day