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Migraine Headaches
What you need to know
What is a Migraine headache?
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Classic migraine
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Has an aura 10 to 30 minutes before a migraine
Common migraine
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does not have an aura, but does have the other
migraine symptoms, such as nausea and vomiting
Aura’s (events that happen before actual
migraine pain developes)
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scotoma (blind spots)
Fortification (zig-zag patterns)
Scintilla (flashing lights)
Unilateral paresthesia/weakness
Hallucinations
Hemianopsia (blindness in one half of the
visual field)
Frequency
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More than 23 million people in the United
States suffer from migraine. Roughly 18% of
females and 6.0% of males get Migraines.
Migraines most commonly are found in
women, with a 3:1 female-to-male ratio.
Half of all Migraine sufferers have their first
attack before the age of 12
Symptoms
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Nausea and vomiting
anorexia and food intolerance
pale and clammy
Photophobia and/or phonophobia
Dizziness
Causes
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Family history of migraine headaches (7080%)
Medications (ie, birth control pills,
vasodilators)
Fatigue or emotional stress
Specific foods or alcohol (caffeine)
Exertion
Triggers
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Lack of Sleep
Noise
Light
Diet
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chocolate, aged cheeses and meats, wine and
beer (ie, sulfites), and citrus fruits.
Medications
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acute (abortive) Therapy
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stop or prevent the progression of a headache or
reverse a headache that has started
preventive (prophylactic) therapy
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aims to reduce the frequency and severity of the
migraine attack
Medications
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Abortive Medications
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Analgesics with caffeine such as Excedrin®
Migraine (acetaminophen, aspirin and caffeine).
Analgesics with caffeine and barbiturates such as
Fiorinal® (butalbital, aspirin and caffeine) and
Fioricet®(butalbital, acetaminophen and caffeine).
Non steroidal antiinflammatory drugs (NSAIDs)
such as Advil® (ibuprofen), and Aleve® (naproxen
sodium).
Medications
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Preventive Medications
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Beta blockers such as Inderal® (propranolol)*, Blocadren ®
(timolol maleate)*, and metoprolol.
Calcium-channel blockers such as Cardizem® (diltiazem)
and Procardia® (nifedipine).
Antidepressants such as Prozac® (fluoxetine), Paxil®
(paroxetine) and Zoloft® (sertraline).
Anticonvulsants such as Depakote® (valproic acid or
divalproex sodium).
NSAIDs such as Orudis® (ketoprofen) and Aleve®
(naproxen sodium).
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Migraine headache. Example of a visual
migraine aura as described by a person
who experiences migraines. This patient
reported that these visual auras preceded
her headache by 20-30 minutes.
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Frank visual field loss can also occur
associated with migraine. This example
shows loss of the entire right visual field
as described by a person who
experiences migraines.
So What do We do as Paramedics?
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Treatment of severe nausea, vomiting, and
subsequent dehydration
Treatment of severe refractory migraine pain
(ie, status migrainosus)
Detoxification from overuse of combination
analgesics, ergots, or opioids
Idea: Maybe dim lights in back of ambulance.
Overall… Treat the symptoms!
Sources used in this Powerpoint
Presentation
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http://www.womenshealth.gov/faq/migraine.h
tm#2
http://www.migrainementors.com/employees/
commonmedications.asp
http://www.emedicine.com/emerg/fulltopic/top
ic230.htm#section~Medication