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Pathology
Pathogenesis unknown – a migraine attack consist of a sequence of phases – prodromal, aura, headache and post-drome.
Classical migraine: Migraine with visual aura
Common migraine: Migraine without visual aura
Hemiplegic migraine: Sporadic or familial – associated with calcium/sodium
channel mutations
Aetiology
Mechanism of migraine remains unclear.
Possibly genetic as tends to be more common in patients with family history.
Triggers: food such as chocolate, cheese etc, exercise, menses, hunger, lack of sleep, stress, combined oral contraceptive pill
.Signs
Prodromal Phase: Nil
Aura Phase: Weakness, parasthesia and hemiparesis
Headache Phase: Photophobia, phonophobia
Symptoms
Prodromal Phase: Non specific symptoms such as difficult concentration, irritability, hunger, excessive yawning, tiredness
Aura phase: Visual symptoms such as scintillations, zigzag lines, scotomas; somatosensory symptoms such as parasthesia and dysphasia
Headache Phase: Unilateral throbbing or pulsating and nausea.
Investigations
Nil as clinical diagnosis
Consider brain imaging in atypical migraine or in the presence of red flags
Treatment
Acute: Aspirin, Paracetamol, NSAIDs, Anti-emetics, Triptans.
Prophylactic: Beta blockers, Pizotifen, Antiepileptic drugs such as Topiramate and
Sodium Valproate, Amitriptyline and Methysergide
Prognosis
Key Facts
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Key Images
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Key References
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