MIGRAINES

Aura headache

Migraines are a mysterious entity afflicting almost 1% of the population. Most migraines follow the POUND mnemonic. 

• Pulsatile or throbbing pain

• One day duration (sleep often has a curative effect)

• Unilateral

• Nausea and photophobia

• Debilitating effect (makes you feel like crap, you just have to lay in bed all day, sort of like a hangover)

What is an aura?

An aura is a premonition. Patients usually describe a “weird feeling” that occurs just prior to the start of the headache. The aura can take many forms, some are simply feelings. Often there are visual shenanigans like pretty geometric lights (scintillating scotoma). Some auras consist of paresthesias. Not everyone gets an aura, but the majority do. For more reading, I strongly recommend Oliver Sack’s “Migraine.” 

Pathophys?

It’s still being figured out. It might involve cerebral vasodilation. This might somehow irritate the trigeminal nerve. 

Diagnosis?

The diagnosis is clinical. If you happened to get an EEG, CT or MRI, it would be completely normal. 

Medications?

Acute treatment consists of NSAIDS, Sumitriptan (Serotonin blocker), Ergots and something for nausea (Metoclopramide, Ondansetron, etc). 

Prevent?

Most migraines are brought on by triggers -- like bright lights, a particular smell, or menstruation. Avoidance of those triggers is obviously a good idea.  Healthy living (lots of rest, healthy meals, plenty of exercise, stress-free) can prevent migraines. Prophylactic treatment consists of Amitriptyline (a TCA), Beta Blockers, Topiramate, Valproic Acid and/or Botox injections. These won’t prevent migraines altogether, but should decrease the frequency.