Pathology: Pathogenesisunknown – a migraine attack consist of a sequence of phases –
prodromal, aura, headache andpost-drome.
Classical migraine: Migraine with visual aura
Common migraine: Migraine without visualaura
Hemiplegic migraine: Sporadic or familial –associated with calcium/sodium
Aetiology: Mechanismof migraine remains unclear.
Possibly genetic as tends to be more common in patientswith family history.
Triggers: food such as chocolate, cheese etc, exercise,menses, hunger, lack of sleep, stress, combined oral contraceptive pill
Prodromal Phase: Non specific symptoms such as difficultconcentration, 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 andnausea.
Signs: ProdromalPhase: Nil
AuraPhase: Weakness,parasthesia and hemiparesis
Investigations: Nilas clinical diagnosis
Consider brain imaging in atypical migraine or in thepresence of red flags
Treatment: Acute: Aspirin, Paracetamol, NSAIDs,Anti-emetics, Triptans.
Prophylactic: Beta blockers, Pizotifen,Antiepileptic drugs such as Topiramate and
Sodium Valproate, Amitriptyline andMethysergide
Pathology: Idiopathic increase in intracranialpressure with no evidence of an underlying structural brain pathology, althoughthought to be due to inadequate absorption of CSF in the arachnoid villi.
Aetiology: Commonly encountered inobese women of child bearing age
Symptoms: Headache worse with coughing,sneezing, bending down, visual obscurations (sometimes worse on bending down),pulsatile tinnitus
Signs Papilloedema. 6thnerve palsy may also be seen [false localizing sign]
Investigations: Bloods: FBC, ESR, haemotinics,coagulation and ANA.
Imaging: CT/MRI to excludestructural brain lesions
Special Tests: Lumbar punctureshows an elevated CSF opening pressure
Humphrey’s visual fields should be performedto assess for defects.
Treatment: Conservative: Weightloss
Medical: Lumbar puncture toreduce CSF pressure or Acetazolamide
Surgical: Optic nervefenestration or lumbo-peritoneal shunt procedure
Complications: Visual loss
Prognosis: 10% have progressive visualloss an optic atrophy
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