Dfinition
- Migraine headaches, are painful and throbbing headaches that last from 4 to 72 hours.
- The cause of migraine headaches are unknown.
- Migraine headaches can be triggered by:
- Stress
- Hunger
- Poor sleep
- Red wine
- Food additives
- Strong odour
- Chocolate
- Noise
Differential diagnosis
Drugs:
- Alcohol abuse
- Stimulant drugs
- Opioids
Infections/Inflammations:
- Meningitis
- Encephalitis
- Brain tumor
- Intracranial hemorrhage
- Sinusitis
- Neck muscle spasm and pain
Metabolic/Mental/Medical:
- Diabetes
- High blood pressure
- Hypoglycemia
- DKA
- Anxiety
Structural:
- Brain mass
- Brain trauma
Symptoms
- The main symptom of migraine headache is a throbbing headache on one side of head
- Nausea and vomiting can be experienced by some people
History taking
- Onset
- Length of headache
- Triggers
- Headache description
- Underlying health problems
- Past history of head trauma
- History of weight loss, low energy, personality changes, …
Management
Prophylactic:
- Beta-blockers
- Propranolol: Start at 20 mg to 40 mg BIDup to maximum of 160 mg daily
- Nadolol: start at 20-40 mg OD up to 160 mg daily
- Metoprolol: start at 50 mg BID up to maximum of 200 mg daily
- Tricyclic Strategy
- Start at 10 mg daily and increase slowly
- Good in patients with insomnia
- Gabapentin
- Magnesium
- Coenzyme Q10
- Divalproex
- Venlafaxine