Migraine Headache

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
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