Migraine

This article provides an extensive overview of migraine, a disorder characterized by recurrent episodes of severe headache, often accompanied by nausea and sensitivity to light and sound. It outlines the phases of migraine, precipitating factors, and details both prophylactic and abortive treatment strategies. The article also discusses medication overuse headache and adjunctive therapies for migraine, highlighting the complexity of migraine management.

Clinical Presentation and Phases of Migraine

Migraine involves recurrent severe headaches typically unilateral and throbbing in nature, with associated premonitory symptoms, aura, headache phase, and postdrome. Triggers include stress, visual stimuli, and dietary factors.

Prophylactic Treatment of Migraine

Preventive therapy, indicated in patients with frequent or long-lasting migraines, includes amitriptyline, venlafaxine, metoprolol, propranolol, verapamil, and erenumab. The goal is to reduce attack frequency and improve responsiveness to acute treatments.

Abortive Treatment of Migraine

Abortive therapy ranges from NSAIDs and acetaminophen to triptans and ergots. Oral antiemetics are used for migraine with severe nausea. Severe attacks may require subcutaneous sumatriptan and intravenous metoclopramide. Status migrainosus is treated with intravenous medications like ketorolac, valproate, or dihydroergotamine.

Medication Overuse Headache

This is a concern with frequent use of acute migraine medications, particularly triptans. Preventive therapy is advised for patients with frequent headaches to avoid medication overuse.

Adjunctive Therapy

Includes dexamethasone for reducing headache recurrence, and advanced treatments like transcranial magnetic stimulation and nerve blocks for severe or refractory cases.

References

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