DR. J IGNESH VORA

Migraine

Overview

Due to complex interactions between neurons and vascular system.

Due to vasodilation of blood vessels.

Triggers

MAM : menstrual associated migraine , due to decreased estrogen level

StressSleep disturbanceFastingBright light (T.V. , movie )OdoursSmoking , alcoholFood : Tyramine (cheese , vine , beer ) , MSGCaffeineRx : nitrates , Ocs

Migraine Triggers

Alcoholic beverages

Hormonalchanges

Weather

Stress

Glare or flickering light

Changes in sleep habit

Phases of migraine

Premonition: eg hunger, energy surges, irritability.

Prodrome: aura.Headache phasePostdrome.

Symptoms

NVDiarrhoeaCold hands and feetBlurred visionThrobbing h’ache (unilateral / bilateral) lasts for 4-72 hrs.Aura 20 %

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. Unilateral2. Pulsating3. Moderately severe.4. Aggravated by physical activity

Consider prevention when

Interferes with patients daily routine.>2/weekAcute medications ineffective or

contraindicated.Presence of uncommon migraine conditions

Hemiplegic migraine Basilar migraine Migraine with prolonged aura.

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.

Rx

NSAIDs , AspirinOmit : alcohol , smokingTriptans : constrict blood vessels & inflammation eg :- Sumatriptan Zolmitriptan Rizatriptan Naratriptan Almotriptan Frovatriptan ADRs :- facial flushing , heart attack , stroke , TIA , narrow arteriesErgots :- dihydroergotamine