Migraine

#med #disease #y2023

Presentation :

Criteria:
- Duration 4-72 hours and at least 2 of the following:
  - Unilateral
  - Pulsatile
  - Moderate-severe intensity that inhibits/prohibits routine activity
  - Aggravated by routine activity (walking down stairs)
- Plus at least 1 of the following:
  - Nausea/vomiting

Acute:
- Mild to moderate: aspirin or NSAID.
- Severe (or failure of 1st line): triptan or dihydroergotamine (SubQ or intranasal if vomiting)
  - CONTRAINDICATED IF:
    - brainstem aura, and hemiplegic migraine
    - MAOI within past 2 weeks
    - Severe liver failure
    - 5-HT1 agonist concurrently (including Zofran)
    - Ischemic heart disease/active CAD, peripheral vascular disease, ischemic bowel disease, cerebrovascular syndromes (2/2 risk of vasospasm)
- Metoclopramide and prochlorperazine are also effective for migraine-associated nausea and enhance the efficacy of the abortive medication.
Prophylaxis:
- Indicated if:
  - migraines do not respond to therapy
  - headache occurs ≥10 days per month
  - disabling headache occurs ≥4 days per month
- Agents:
  - metoprolol, propranolol, or timolol
  - divalproex, or topiramate