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Migraine Diagnosis and treatment of the attack

Migraine Diagnosis and treatment of the attack. David Kernick St Thomas Health Centre Exeter. Classifying headache. Migraine Tension type Cluster. Traumatic Vascular Non-vascular Substance induced Infection Metabolic Facial structures.

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Migraine Diagnosis and treatment of the attack

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  1. MigraineDiagnosis and treatment of the attack David Kernick St Thomas Health Centre Exeter

  2. Classifying headache

  3. Migraine Tension type Cluster Traumatic Vascular Non-vascular Substance induced Infection Metabolic Facial structures IHS Headache classificationPrimary Secondary

  4. What do people think when they present with headache? • I need glasses (<1% headache due to undiagnosed refractive errors) • Its my blood pressure • I have a tumour (1 in 1000 risk)

  5. Withdrawal of all analgesia Increased frequency of headache, associated with increased frequency of analgesia use. Return of episodic headache Daily headache with spikes of more severe pain Medication overuse headache Headache intensity Migraine attacks Frequent ‘daily’ headaches

  6. Is it migraine?

  7. Simple Diagnostic aid • Migraine – have to lie down • Tension headache – can keep going • Cluster Headache – have to bang head

  8. Formal Migraine • 4-72 hours • Two of : unilateral, pulsating, moderate or severe pain, aggregation by physical activity. • At least one of: nausea/vomiting, photophobia, phonophobia.

  9. Other diagnostic pointers for migraine • I feel nauseated • I don’t like light or sound • Movement makes things worse

  10. MigraineBackground

  11. Impact of migraine • In top 20 of WHO disability index • 1000,000 people loose work or school each day • Over £2 billion cost p.a. in absenteeism Steiner 2003

  12. What is migraine?

  13. Migraineurs brains are different Problems with change

  14. AURA Medication overuse headache Thalamus + Mid Brain structures Tension type headache Hypothalamus CLUSTER CERVICAL NUCLEI MIGRAINE CENTRE Headache model Migraine: aura - activation migraine centre – modulation – Inflammation at brain surface

  15. What is happening in Migraine?

  16. Migraine and the neck

  17. The Migraine attack • Prodrome • Aura (movement, sensation, +,-) • Headache • Postdrome

  18. Aura without pain

  19. The management of acute migraine

  20. Some thoughts about medication

  21. Drug treatment

  22. Licensed or unlicensed? Generic or proprietary?

  23. Benefit v disadvantages

  24. Placebo effect

  25. Is a drug worth paying for? NICE

  26. Migraine treatmentAcute • Paracetamol (3)/Aspirin (3)/ Domperidone (Motilium 3)

  27. Migraine treatmentAcute • Paracetamol/Asp/Domperidone • Rectal NSAI/Domperidone

  28. Migraine treatmentAcute • Paracetamol/Asp/Domperidone • Rectal NSAI/Domperidone • Triptan

  29. The Triptans • Work on the migraine pathway • Tablets, melts, nasal spray, injection. • Side effects • Failure response is not a class effect

  30. Triptan Half Life

  31. Triptans in the elderly

  32. For the migraine attack • Motilium (10mg) – 2 tablets for nausea • Paracetamol (500mg) – 3 tablets for pain • Soluble Asprin (300 mg) – 3 tablets for inflammation • Imigran (50mg) migraine specific – 1 or 2

  33. Getting the best out of you GP • Emphasise the impact • Help with diagnosis • Help with triggers • Reassure that you don’t expect a scan • Direct to information • Ask to be referred • Help yourself

  34. MigraineDiagnosis and treatment of the attack David Kernick St Thomas Health Centre Exeter You Tube Migraine channel or David Kernick Channel

  35. Migraine treatment - Preventative Evidence • Beta blocker ++ (L) • Pizotifen + - (L) • Amitriptyline + • Sodium valproate + + • Topiramate ++ (L) • Calcium antagonists + - • Lisinopril, Montelukast + - • Methylsergide +++ (L)

  36. Migraine treatment - Preventative • Feverfew • Butterbur • Magnesium • Riboflavin • Coenzyme Q10

  37. Migraine treatment - Preventative

  38. THE BEST THING YOU CAN DO FOR YOUR MIGRAINE IS TO GIVE UP FAGS, BOOZE AND FRIED FOOD

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