Migraine

Presentation

• Unilateral throbbing headache preceded by an aura, such as visual (e.g. lines, zigzags) or sensory (paraesthesia spreading from fingers to face)

  • Headache may last up to 72 hrs

• Photophobia

• Phonophobia

• N+V

There tends to be an identifiable trigger. Examples of these include stress, bright lights, strong smells, certain foods, dehydration, contraceptive pill, menstruation.

Diagnosis

• Clinical – History is key

• Presence of aura helps confirm the diagnosis

• In headaches w/o aura:

  • 5+ headaches lasting up to 72 hours, with N+V or photo/phonophobia AND 2 of unilateral headache, pulsating character, impaired or worsened by daily activities

Management

Acute attack - Sumatriptan +/- NSAID/Paracetamol

Prophylactic:

• Headache diary to identify and avoid triggers

• Propranolol, Topiramate or Amitriptyline

  • Propranolol should be avoided in asthmatics

  • Topiramate is teratogenic, so avoid in pregnant women

N.B. The COCP is a contraindication here as it increases the risk of ischaemic stroke.