Migraine- management

Migraine is a Chronic , complex , genetically determined neurological disorderIt is a Primary episodic headache disorder- ie not associated with an underlying pathology other examples include migraine , tension-type and cluster headache

Often ( but not always ) unilateral throbbing pulsating headache with associated symptoms ○ photophobia○ phonophobia ( sensitivity to sound )○ nausea and vomitinglasting 4-72 hrsSubdivided into migraine with and without aura , defined as episodic or chronic

Headache classification system - most commonly used is the system published by the International Headache Society

Migraine is the most common severe form of primary headache - one of 5 leading cause of long term disability

High socioeconomic cost ( UK- around £ 3 billion / Y)

Three times more common in women

Prevalence declines with age in both sexes

BASH guidance -Metoclopramide 10 mg ( not more than 5 days )

Domperidone 10 mg tds ( less sedating than metoclopramide and less risks of extra-pyramidal SEs , upto a week

If vomiting restricts use consider ○ zolmitriptan nasal spray○ diclofenac suppository○ buccal preparation such as Buccastem® 3-6 mg up to twice in 24 hrs

Avoid aspirin if < 16 yrs of age

Metoclopramide is not recommended for children...