dr jignesh vora

1. D R . J I G N E S H V O R A
Migraine

2. Overview
Due to complex interactions between neurons and
vascular system.
Due to vasodilation of blood vessels.

3. Triggers
MAM : menstrual associated migraine , due to
decreased estrogen level
Stress
Sleep disturbance
Fasting
Bright light (T.V. , movie )
Odours
Smoking , alcohol
Food : Tyramine (cheese , vine , beer ) , MSG
Caffeine
Rx : nitrates , Ocs

4. Migraine Triggers
Alcoholic
beverages
Hormonal
changes
Weather
Stress
Glare or
flickering light
Changes in
sleep habit

5. Phases of migraine
Premonition: eg hunger, energy surges, irritability.
Prodrome: aura.
Headache phase
Postdrome.

6. Symptoms
NV
Diarrhoea
Cold hands and feet
Blurred vision
Throbbing h’ache (unilateral / bilateral)
lasts for 4-72 hrs.
Aura 20 %

7. Migraine: IHS criteria
5 attacks of
Headache lasting 4-72 hours.
Must be associated with nausea or vomiting or
photophobia and phonophobia
Must have 2 of the following
1. Unilateral
2. Pulsating
3. Moderately severe.
4. Aggravated by physical activity

9. Consider prevention when
Interferes with patients daily routine.
>2/week
Acute medications ineffective or contraindicated.
Presence of uncommon migraine conditions
 Hemiplegic migraine
 Basilar migraine
 Migraine with prolonged aura.

10. Triptans
oral triptans are effective and well tolerated.
Rizatriptan 10mg, eletriptan 80mg and
almotriptan 12.5 mg were the most effective.
40-80% two hour headache response.
Give as early as possible in migraine attack.
Nasal spray or S/C injection may be more effective.

11. Rx
NSAIDs , Aspirin
Omit : alcohol , smoking
Triptans : constrict blood vessels &
inflammation
eg :- Sumatriptan
Zolmitriptan
Rizatriptan
Naratriptan
Almotriptan
Frovatriptan
ADRs :- facial flushing , heart attack , stroke , TIA ,
narrow arteries
Ergots :- dihydroergotamine