1. INTERNAL MEDICINE

2. Migraine Def: A migraine headache is a throbbing or pulsating headache that is often one sided (unilateral) and associated with nausea; vomiting; sensitivity to light, sound, and smells; sleep disruption; and depression.

3. Migraine Aetiology: Exact cause is unknown Heredo-familial 50% Precipitating factors- Alcohol Bright lights Certain odors or perfumes Changes in hormone levels

4. Migraine Aetiology: Precipitating factors- Changes in sleep patterns Exercise Loud noises Missed meals Physical or emotional stress Smoking or exposure to smoke Baked goods Chocolate Foods containing monosodium glutamate (MSG)

5. Migraine Classifications: 1.Classical migraine- visual or sensory symptoms precede or accompany the headache 2.Common migraine- no visual and sensory features with headache, nausea and vomiting 3.Hemiplegic migraine- prolonged headache lasting or days 4.Basilar migraine- Occipital headache proceed by vertigo, diplopia, dysarthria 5.Cluster headache- Bouts of severe pain around the one eye with associated epiphora and nasal congestion

6. Migraine Clinical features: A temporary blind spot Blurred vision Eye pain Seeing stars or zigzag lines Tunnel vision Feel throbbing, pounding, or pulsating Are worse on one side of the head Start as a dull ache and get worse within minutes to hours Last 6 to 48 hours

7. Migraine Clinical features: Chills Increased urination Fatigue Loss of appetite Nausea and vomiting Numbness, tingling, or weakness Problems concentrating, trouble finding words Sensitivity to light or sound Sweating

8. Migraine D/D: DNS with frontal or maxillary sinusitis Intracranial tumour(occipital lobe) in early stage

9. Migraine Investigations: CBC Plain x-ray of skull X-ray PNS O/M view CT

10. Migraine Management: A.General measures- Reassurence and relief of anxiety Avoidance of precipitating factors such as oral contracetives B.Treatment during acute attacks- Analgesics(paracetamol or aspirin) with antiemetics(dompredone) In severe attacks- Ergotamine tartrate 0.5-1.0 mg sublingually Tab. Sumatriptan 100 mg

11. Migraine Management: C.Prophylaxis- Propranolol 40-80 mg 8 hrly and pizotifen 1.5-3.0 mg at night Antidepressants such as amitriptyline 25-100 mg at night Methysergide 1-2 mg 8 hrly in resistant case