1. Migraine Headaches What you need to know

2. What is a Migraine headache? Classic migraine – Has an aura 10 to 30 minutes before a migraine Common migraine – does not have an aura, but does have the other migraine symptoms, such as nausea and vomiting

3. Aura’s (events that happen before actual migraine pain developes) scotoma (blind spots) Fortification (zig-zag patterns) Scintilla (flashing lights) Unilateral paresthesia/weakness Hallucinations Hemianopsia (blindness in one half of the visual field)

4. Frequency 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

5. Symptoms Nausea and vomiting anorexia and food intolerance pale and clammy Photophobia and/or phonophobia Dizziness

6. Causes Family history of migraine headaches (70- 80%) Medications (ie, birth control pills, vasodilators) Fatigue or emotional stress Specific foods or alcohol (caffeine) Exertion

7. Triggers Lack of Sleep Noise Light Diet – chocolate, aged cheeses and meats, wine and beer (ie, sulfites), and citrus fruits.

8. Medications acute (abortive) Therapy – stop or prevent the progression of a headache or reverse a headache that has started preventive (prophylactic) therapy – aims to reduce the frequency and severity of the migraine attack

9. Medications Abortive Medications – 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).

10. Medications Preventive Medications – 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).

11. 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.

12. 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.

13. So What do We do as Paramedics? 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!

14. Sources used in this Powerpoint Presentation http://www.womenshealth.gov/faq/migraine.h tm#2 http://www.womenshealth.gov/faq/migraine.h tm#2 http://www.migrainementors.com/employees/ commonmedications.asp http://www.migrainementors.com/employees/ commonmedications.asp http://www.emedicine.com/emerg/fulltopic/top ic230.htm#section~Medication