Migraine Headache

• 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

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

• The main symptom of migraine headache is a throbbing headache on one side of head
• Nausea and vomiting can be experienced by some people

• Onset
• Length of headache
• Triggers
• Headache description
• Underlying health problems
• Past history of head trauma
• History of weight loss, low energy, personality changes, …

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