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Management of Migraine
Presented by: Anish Dhakal (Aryan)
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
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
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
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
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
3.Hemiplegic migraines
• Rare
• autosomal dominant disorder
• hemiparesis, headache, come
• Recovery with in 24 hours
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
Management
1.Non -pharmacological
• Explanation
• Avoidance of trigger factors and lifestyle
modification
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
• 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
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
• Bolulinum toxin -given for chronic migraine
• -31 injection over the scalps
and neck repeated every 3 month.
References
• Davidson’s Principle and Practice of
Medicine, 22nd edition
• Kumar and Clark, clinical medicine, 8th
edition
THANK YOU

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Migraine 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