Data gathering
- Red flags – balance, coordination, limb weakness, COCP
- Others – triggers, n&v, visual symptoms, photophobia
- Examine – BP, CN, PNS upper/lower, fundoscopy
Clinical management
- Explanation
- exact mechanism unknown, spasming and subsequent widening of blood vessels thought to contribute
- Treatment
- Lifestyle – Avoid triggers
- Acute – triptans, NSAIDs, paracetamol, anti-emetic
- Prophylaxis – topiramate (if not child bearing), propranolol
- Follow-up / Safety net – if worsening, weakness, balance affected, rw again
Triptans
- take as soon as pain starts
- can take again after 24 hours
- CI: MI, Stroke, PVD
- can get medication induced headache if taken too often