Migraine Headache

Management of migraine which has one of the very common presentation as chronic headache

1. M anagement of Migraine Presented by: Anish Dhakal (Aryan)

2. M igraine 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. C linical 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. M anagement 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, 22 nd edition Kumar and Clark, clinical medicine, 8 th edition

15. THANK YOU