INTERNAL MEDICINE

Migraine

Def: A migraine headache is a throbbing or pulsating

headache that is often one sided (unilateral) and associated with nausea; vomiting; sensitivity to light, sound, and smells; sleep disruption; and depression.

Migraine

Aetiology: Exact cause is unknown Heredo-familial 50% Precipitating factors- Alcohol Bright lights Certain odors or perfumes Changes in hormone levels

Migraine

Aetiology: Precipitating factors- Changes in sleep patterns Exercise Loud noises Missed meals Physical or emotional stress Smoking or exposure to smoke Baked goods Chocolate Foods containing monosodium glutamate

(MSG)

Migraine

Classifications: 1.Classical migraine- visual or sensory symptoms

precede or accompany the headache 2.Common migraine- no visual and sensory

features with headache, nausea and vomiting 3.Hemiplegic migraine- prolonged headache

lasting or days 4.Basilar migraine- Occipital headache proceed

by vertigo, diplopia, dysarthria 5.Cluster headache- Bouts of severe pain around

the one eye with associated epiphora and nasal congestion

Migraine

Clinical features: A temporary blind spot Blurred vision Eye pain Seeing stars or zigzag lines Tunnel vision Feel throbbing, pounding, or pulsating Are worse on one side of the head Start as a dull ache and get worse within

minutes to hours Last 6 to 48 hours

Migraine

Clinical features: Chills Increased urination Fatigue Loss of appetite Nausea and vomiting Numbness, tingling, or weakness Problems concentrating, trouble finding words Sensitivity to light or sound Sweating

Migraine

D/D: DNS with frontal or maxillary sinusitis Intracranial tumour(occipital lobe) in early stage

Migraine

Investigations: CBC Plain x-ray of skull X-ray PNS O/M view CT

Migraine

Management: A.General measures- Reassurence and relief of anxiety Avoidance of precipitating factors such as

oral contracetives B.Treatment during acute attacks- Analgesics(paracetamol or aspirin) with

antiemetics(dompredone) In severe attacks- Ergotamine tartrate 0.5-1.0 mg sublingually Tab. Sumatriptan 100 mg

Migraine

Management: C.Prophylaxis- Propranolol 40-80 mg 8 hrly and pizotifen 1.5-3.0

mg at night Antidepressants such as amitriptyline 25-100 mg

at night Methysergide 1-2 mg 8 hrly in resistant case