Migraine Scenario (Technician)

Are migraines a primary, secondary, or tertiary headache?

The patient expressed that this migraine has been different from previous ones. What red flags should we exclude when considering more serious differentials? 

Your patient hasn’t felt any new symptoms with this migraine, his concern was the length of time and increased severity as previous headaches have lasted a maximum of 12 hours. He is reporting a throbbing, unilateral headache with associated severe nausea (with vomiting the day previously), photophobia and phonophobia. What is phonophobia?

What treatment can we offer the patient at this stage which may help in their condition?

You give appropriate medication and the patient starts to improve slightly. He explains this seems to happen each time he has pain relief but within one hour, the pain will become severe again. You can’t find any red flags and think this headache is just a more severe, prolonged presentation of his normal migraine? 

Given the history of the patient and the differences in presentation compared to normal, what pathway may be most appropriate for this patient? 

What is status migrainosis?

Once status migrainosis is confirmed, it is recommended that a patient be considered for hospital admission by NICE guidelines, why is this?

Migraines are associated with an increased risk in ischaemic stroke?

What are some of the common medications you see prescribed to migraine patients that could further aid your pain management?

Chronic migraine sufferers often have multiple forms of pain relief to control their symptoms and can be at higher risk of medication-overuse headaches. What criteria does this include?

If a patient reports an aura before their migraine with symptoms such as; duration greater than 60 minutes, motor weakness, double vision, visual symptoms affecting only one eye or impaired balance, does this constitute as a red flag symptom according to NICE guidelines?

What are some of the commonly reported triggers that are associated with the onset of migraine?

If other household contacts present with similar symptoms of severe headache, what other differentials could this suggest?

If discharging a patient at home with a presentation of headache, JRCALC states there MUST be follow-up care arranged (preferably own GP or out of hours) and ideally patients should not be left alone whilst awaiting follow up?

The International Classification of Headache Disorders can be used to help describe the diagnostic criteria for all headache subgroups?