Managing Migraine
Australia’s Health 2010 ranks migraine as one of the ten most common long-term conditions affecting Australians aged 25-64 years.
A migraine substudy of the BEACH (Bettering the Evaluation and Care of Health) program, revealed that 11.5% had been diagnosed with migraine. GPs reported a higher prevalence in females (14.9%) than among males (6.1%) with peak prevalence between 25 and 44 years.
Migraine without aura (common migraine) is characterised by:
• Recurrent episodes;
• Unilateral, throbbing pain;
• Often accompanied by nausea and vomiting.
Migraine with aura (classical migraine) is associated with:
• Focal neurological symptoms;
• Visual disturbances;
• Dizziness;
• Parasthesiae;
• Impaired speech.
Initial migraine management should include advising the patient to rest in a quiet, darkened room and avoiding movement or activity (including reading or watching TV). Encourage patients to take an active role in managing their pain by using relaxation exercises, stress management and reducing caffeine intake.
Migraine treatment guide
Mild to moderate migraine:
• Trial a simple analgesic – aspirin, NSAID or paracetamol.
• For nausea and vomiting – add metoclopramide, domperidone or prochlorperazine.
When migraine is severe and/or debilitating, or if pain persists following initial treatment with simple analgesics:
• Use 5-HT1 agonist (triptans); or
• Ergotamine or dihydroergotamine;
• Triptans and ergotamine/dihydroergotamine should not be taken within 24 hours of each other.
With experience, patients should be able to identify which course of treatment is most effective for managing migraine. Using the appropriate treatment promptly, at the onset of migraine headache, may be more effective than delaying treatment until pain is severe.
Coadministration of 5-HT1 agonists with drugs having serotonergic activity, such as SSRIs and SNRIs, may increase the risk of serotonin syndrome. If concomitant treatment with triptans and a serotonergic active drug is clinically warranted, caution is advised.