Neurology
Headache: Migraine
آدھے سر کا درد
A headache is usually associated with infection (URTI, LRTI, enteric fever, malaria). If isolated, the main causes are migraine and tension-type headache. Migraine is unilateral (female patients), lasts hours to 2–3 days, preceded by aura (zig-zag lines), precipitated by menstruation, flashing light, anxiety, etc.
- ICD-10
- —
- Source
- OPD handbook pp.165–166
- Status
- Draft
Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.
Symptoms
- Unilateral headache (female patients)
- Lasts for hours to 2–3 days
- Preceded by aura (zig-zag lines)
- Precipitated by menstruation, flashing light, anxiety, etc.
Diagnosis
- Examination: unremarkable
- Labs: normal
Treatment
Step 1 of 3
1. Acute attack
- Triptans, i.e. sumatriptan
- NSAIDs: naproxen
- Multivitamins
Prescription
Sumatriptan + NaproxenTriptan + NSAID (migraine)
Dose1 tablet at the time of the headache
Brand Tab Sumoxen 85/500
NaproxenNSAID
Dose1+1
Brand Tab Neoprox 500 mg
5 days
Also sold as Neoprox, Neopron, Flexin, Synflex
Methylcobalamin (vitamin B12)Nervine tonic / B12
Dose1+0 daily
Brand Tab Mexamin 500 mcg
Also sold as Neuromet, Mexamine, Cobalamin, Mexamin, Methycobal
Step 2 of 3
2. Prophylaxis
- Beta-blockers (propranolol)
- Calcium-channel blocker (the drug name written in brackets is hard to read)
Prescription
Step 3 of 3
3. Counselling (Urdu notes)
- Avoid cough/cold triggers and cola drinks (as read)
- Sleep properly
- Avoid cold things, tea/coffee and strong smells
- Avoid loud noise and bright light
Sample prescription from the book (patient details removed)
- Female, 18 y, unilateral headache with episodes lasting 2–3 days; non-tender: Tab Sumoxen 85/500 1 tablet at the time of headache; Tab Neoprox 500 mg 1+1 for 5 days. Discharge: Tab Inderal 10 mg 1+1; Tab Mexamin 500 mcg 1+0 daily.