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Background Knowledge ๐Ÿง 


Migraine is a primary headache disorder characterized by recurrent headaches that are moderate to severe. Typically, the headache affects one half of the head, is pulsating in nature, and lasts from 4 to 72 hours.


The exact cause of migraines is unknown, but they are thought to result from abnormal brain activity temporarily affecting nerve signals, chemicals, and blood vessels in the brain.

  • Genetic factors: Family history of migraine.
  • Environmental factors: Stress, certain foods, hormonal changes.


Migraine pathophysiology involves a complex interplay between the nervous and vascular systems. Key aspects include:

  • Cortical spreading depression: A wave of neuronal and glial depolarisation.
  • Trigeminovascular system activation: Leads to the release of vasoactive neuropeptides.
  • Sensitisation: Increased response to stimuli.

Clinical Features ๐Ÿฉบ

Clinical Features

  • Prodrome: Symptoms that occur hours or days before the headache, such as mood changes, neck stiffness, and food cravings.
  • Aura: Visual disturbances (e.g., flashing lights, zigzag lines), sensory changes (e.g., tingling), or speech disturbances.
  • Headache: Unilateral, pulsating pain, often accompanied by nausea, vomiting, photophobia, and phonophobia.
  • Postdrome: Feeling drained or refreshed, mood changes, and mild head pain.

Investigations ๐Ÿ”ฌ


Diagnosis is primarily clinical based on history and physical examination.

  • Imaging: MRI or CT scan if atypical features are present or secondary headache is suspected.
  • Blood tests: To rule out other conditions if indicated.

Management ๐Ÿฅผ


  • Acute treatment: NSAIDs, triptans, antiemetics.
  • Preventive treatment: Beta-blockers, antiepileptics, antidepressants.
  • Lifestyle modifications: Regular sleep, diet, and exercise; stress management.
  • Non-pharmacological treatments: Cognitive behavioural therapy, biofeedback, acupuncture.

Complications โš ๏ธ


  • Status migrainosus: Severe migraine lasting more than 72 hours.
  • Medication-overuse headache: Resulting from chronic use of headache medications.
  • Increased risk of stroke: Especially in women with aura.

Key Points ๐Ÿ“Œ

Key Points

  • Migraines are a common and disabling headache disorder.
  • Diagnosis is clinical, but imaging may be necessary in atypical cases.
  • Management includes acute treatment, preventive strategies, and lifestyle modifications.
  • Understanding triggers and individualising treatment are key to effective management.

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