Migraine

G43.0-3/G43.8-9

DESCRIPTION

A migraine is an episodic headache, usually located unilaterally and throbbing/ pulsating in nature, which may occur with or without an aura. Migraines are usually accompanied by nausea and/or vomiting, photophobia (sensitivity to light) and phonophobia (sensitivity to noise). There are several variants of migraine.

GENERAL MEASURES

Reassure patient that this is a benign condition.

Attempt to identify any precipitating factors or food triggers from the patient’s history.

MEDICINE TREATMENT

Acute treatment

Initiate therapy during the migraine attack or at the onset of the headache.

Analgesia:

  • Paracetamol, oral, 1 g 4–6 hourly when required.
    • Maximum dose: 15 mg/kg/dose.
    • Maximum daily dose: 4 g in 24 hours.

OR

  • NSAID, e.g.:
  • Ibuprofen, oral, 400 mg immediately then 8 hourly with meals, if needed.

For nausea:

  • Metoclopramide, oral/IM, 10 mg 8 hourly, as required.

Prophylaxis (Z29.2)

Regular, daily, prophylactic therapy is advised if:

  • attacks are frequent, i.e. more than 2–3 per month, or
  • severe, causing a significant amount of disability, or
  • attacks are long lasting, or
  • patient poorly tolerates therapy for acute attacks.

LoEIII [44]

  • Amitriptyline, oral, 10–25 mg at bedtime.
    • Up-titrate dose to adequate clinical response.
    • Doses greater than 25–75 mg are seldom required.

LoEI [45]

OR

Poor response or contraindication to amitriptyline:

  • β-blocker, e.g.:
  • Propranolol, oral, 40 mg 12 hourly.
    • Titrate dose to adequate response
    • Maximum dose 120–240 mg daily.

LoEI [46]

REFERRAL

Inadequate response to treatment.