5th August 2024

Migraine

Migraine is a common neurovascular disorder affecting around 1 in 6 people. It commonly occurs in young to middle-aged females. There is a strong genetic component to the disorder with around half of migraine sufferers reporting a family history. Migraines are thought to be caused by an inflammatory process in the brain resulting in non-painful stimuli being perceived as painful, for example sound and light.

• The headache follows a chronic, episodic course with each episode lasting approximately 4-72 hours.
• It is described as a severe throbbing pain which is made worse by normal daily activities and associated with photophobia, phonophobia and nausea.
• Migraine can be split into two types: migraine with aura and migraine without aura. Auras typically consist of temporary unilateral sensory or visual disturbances, however they can also include motor symptoms in cases of hemiplegic migraine.
• Acute symptomatic treatment options include combination therapy with an oral triptan and NSAID or oral triptan and paracetamol. Alternatively, monotherapy with paracetamol, aspirin, NSAIDs or a triptan can be offered. Antiemetics should also be offered if needed. Triptans should be avoided in migraine with hemiplegic aura as they may increase the chance of stroke.
• Preventative measures include trigger avoidance and pharmacological therapies. In those patients who wish to start preventative medication, topiramate or propranolol should be offered. Topiramate is teratogenic and, therefore, should be avoided in females of childbearing age.  Other preventative options include amitriptyline, venlafaxine and verapamil.
• It is also important to ensure that those who experience migraine with aura are not taking a combined oral contraceptive pill as this will increase their risk of stroke.
• Migraines can be disabling, however the majority of patients respond well to treatment and the frequency of episodes generally decreases with age.