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4/3: Elderly/Neuro Y3/4 - Neuro and Stroke [12] > [14] Migraine > Flashcards

[14] Migraine Flashcards

1
Q

What is the definition of migraine?

A

A primary headache disorder characterised by recurrent headaches that are moderate to severe

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2
Q

How many main types of migraine are there?

A

3

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3
Q

What are the 3 main types of migraine?

A
  • Migraine with aura
  • Migraine without aura
  • Migraine aura without headache
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4
Q

What are the two classifications of migraines?

A

Episodic and chronic

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5
Q

What is chronic migraine?

A

When headache is present on at least 15 days a month with at least 8 days where headache and other symptoms meet diagnostic criteria for migraine

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6
Q

What is thought to be the underlying pathology of migraines?

A

Neurovascular disorder staring in the brain and then affecting blood vessels

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7
Q

What is thought to be the pathophysiology of migraines?

A

NMDA receptor activation causing cellular calcium influx and depolarisation. This causes a decreased blood flow to the cortex. Depolarisation spreads through pain receptors in the head and neck

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8
Q

Is the actual mechanism of headache pain in migraines known?

A

No.

So probably don’t bother with the pathophysiology at all tbh

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9
Q

What are the risk factors for migraines?

A
  • Female

- Family history

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10
Q

What are the characteristic presenting symptoms of migraine?

A
  • Paroxysmal headaches
  • Premonitory phase
  • Resolution phase
  • Concentration and mood changes
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11
Q

Describe a typical migraine headache

A

Severe and unilateral (mostly)

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12
Q

What percentage of migraine headaches are bilateral?

A

30-60%

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13
Q

What percentage of migraines have a premonitory phase?

A

20-60%

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14
Q

What are the symptoms experienced in the premonitory phase of migraine?

A
  • Fatigue
  • Mood changes
  • GI symptoms
  • Nausea
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15
Q

What happens in the resolution phase of migraine?

A

The headache gets gradually better

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16
Q

How many attacks must a patient have had to be diagnosed with migraine without aura?

A

At least 5

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17
Q

How long does the headache last in migraine without aura?

A

4-72 hours

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18
Q

A headache in a migraine without aura has at least 2 of what features?

A
  • Unilateral
  • Pulsating
  • Moderate to severe
  • Aggravated by routine physical activity
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19
Q

In addition to headache at least one of what other symptoms are present in migraine without aura?

A
  • Nausea and vomiting

- Photophobia and phonophobia

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20
Q

What percentage of people with migraine without aura experience N&V?

A

At least 60%

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21
Q

What proportion of migraine sufferers experience migraine with aura?

A

About 1/3

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22
Q

What are the phase of migraine with aura?

A
  • Premonitory phase
  • Aura
  • Migraine
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23
Q

When does the premonitory phase in migraine with aura occur?

A

Hours to days before

24
Q

What are the common features of the premonitory phase of migraine with aura?

A
  • Depression
  • Tiredness
  • Difficulty concentrating
  • Irritability
  • Stiff neck
  • Food cravings
25
Q

How does the nature of aura vary in migraine with aura?

A

Highly variable between individuals but is usually consistent for individuals

26
Q

What is the timing of aura in migraine with aura?

A

Progress over minutes and last minutes to an hour before headache

27
Q

What are some aura features in migraine with aura?

A
  • Visual disturbances

- Sensory symptoms

28
Q

What visual disturbance can occur in migraine with aura?

A
  • Geometric patterns

- Hallucinations

29
Q

How do visual disturbances onset in migraine with aura?

A

Usually start in one eye then may spread

30
Q

What sensory symptoms can occur as part of an aura in migraine with aura?

A

Unilateral paraesthesia or numbness

31
Q

What is the migraine in migraine with aura like?

A

Same as migraine without aura

32
Q

What is a menstrual migraine?

A

A migraine without aura occurring regularly within two days before onset of menstruation and no other time

33
Q

What may be seen on examination in a patient with a migraine?

A
  • Localised oedema
  • Scalp tenderness
  • Prominence of temporal blood vessels
  • Neck stiffness and tenderness
34
Q

When are investigations required in migraine?

A

Only to exclude an alternative diagnosis if one is suspected

35
Q

When is referral to a neurologist required?

A

After failure of second-line management of acute symptoms or diagnosis is uncertain

36
Q

What features are suggestive of a more serious pathology?

A
  • New headache in over 50 or under 10s
  • Headache with long lasting aura
  • Systemic symptoms
  • ‘Worst ever headache’
  • Change in features and timing
  • Scalp tenderness
  • Jaw claudication
  • Focal neurological symptoms
37
Q

What are some differentials for migraine?

A
  • Other forms of headache
  • Giant cell arteritis
  • Subarachnoid haemorrhage
  • Cerebral neoplasm
  • Systemic or CNS infection
  • Arterial dissection
  • Cerebral venous thrombosis
  • Ischaemic stroke
38
Q

What other headaches could be differentials for migraine?

A
  • Tension
  • Cluster
  • Medication-overuse
  • Post-traumatic
39
Q

What are the aims of migraine management?

A
  • Relieve symptoms
  • Reduce frequency
  • Reduce severity
  • Identify triggers
40
Q

What is step 1 in managing the symptoms of an acute migraine?

A

Simple analgesic with/without anti-emetic

41
Q

What simple analgesics can be tried to combat migraine?

A

Soluble aspirin 600-900mg OR

ibuprofen 400-600mg

42
Q

What is step 2 in managing the symptoms of an acute migraine?

A

Rectal analgesia and rectal anti-emetic

43
Q

What rectal therapies should be given for acute migraine symptoms?

A

100mg diclofenac with 30mg domperidone (if needed)

44
Q

What is step 3 in managing the symptoms of an acute migraine?

A

Specific ant-migraine drugs

45
Q

What are some examples of anti-migraine drugs?

A
  • Triptans (5HT1 agonists)

- Ergotamine

46
Q

When should patients be offered prophylaxis to reduce migraine frequency?

A

When they have 2 or more attacks per month

47
Q

What are the first line prophylactic agents for migraine?

A
  • Beta blockers

- Amitriptyline

48
Q

What are the second line prophylactic agents for migraine?

A
  • Topiramate

- Sodium valproate

49
Q

What are the third line prophylactic agents for migraine?

A
  • Pizotifen
50
Q

What can help to identify triggers of migraine?

A

An ‘attack and trigger’ diary

51
Q

What can an attack ad trigger diary help with?

A

Determining if certain avoidable behaviours are linked to migraine onset

52
Q

What are some examples of possible avoidable migraine triggers?

A
  • Stress
  • Bright lights
  • Loud noise
  • Anxiety
  • Dietary sensitivities
  • Sleep deprivation
53
Q

What are the potential complications of migraine?

A
  • Increased risk of psychiatric disorders
  • Status migrainosus
  • Migrainous infarction
  • Increased risk of ischaemic and haemorrhagic stroke
54
Q

What psychiatric disorders is a person at increased risk of developing with migraines?

A
  • Depression
  • Bipolar
  • GAD
  • Panic disorder
55
Q

What is status migrainosus?

A

Debilitating migraine that lasts for more than 72 hours

56
Q

What is a migrainous infarction?

A

When cerebral infarction occurs during the course of a typical attack of migraine with aura

4/3: Elderly/Neuro Y3/4 - Neuro and Stroke [12] (33 decks)

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