Exam 3: Migraine Flashcards
Migraine without Aura
most common
at least five attacks
headaches lasting 4-72 hours
unilateral location, pulsating quality, moderate/severe pain, aggravation by routine activity
N/V, photophobia, phonophobia
Migraine with Aura
classic
at least 2 attacks
at least one fully reversible aura
no aura lasting more than 60 minutes
headache follows aura within 60 minutes
visual, sensory, speech/language, motor, brainstem, retinal
Migraine Headache Phases: Prodrome
hours or days before onset of headache
may experience euphoria, depression, irritability, food craving, constipation, neck stiffness, yawning
Migraine Headache Phases: Aura (15-30% of patients)
commonly visual, may be sensory, verbal, or motor
before or during migraine, lasts less than 60 minutes
photopsia, scotoma, zigzag lines, numbness/tingling in arms, legs, face
Migraine Headache Phases: Migraine Headaches
dull ache that intensifies
unilateral and throbbing
phonophobia, photophobia
Migraine Headache Phases: postdromal
may last several days after headache has ended
tiredness, head pain, GI distress, weakness, cognitive difficulties
Migraine Triggers: Medication Overuse
associated with analgesics, ergots, triptans: rebound headaches from medications overuse more than 2x per headache or two times per week chronically
Migraine Triggers: Medications
oral contraceptives
hydralazine
nitroglycerine
nifedipine
cocaine
Migraine Triggers: Diet
chocolate
oranges
tomatoes
onions
aged cheese
processed meats
cultured dairy
alcohol (red wine and champagne)
caffeine
Migraine Triggers: additives/preservatives
aspartame
monosodium glutamate
Migraine Triggers: environment
altitude/weather changes
perfume
tobacco smoke
loud noises
flickering lights
Migraine Triggers: Other
too little/too much sleep
skipping meals
stess
hormone changes
General Treatment Overview
avoid analgesic overuse
Abortive Treatment
education to avoid medication overuse
mild to moderate: NSAIDs, acetaminophen
moderate-severe: triptans/ergots
Preventative Treatment
four or more attacks/month with disability at least 3 days/month
Abortive Treatment First Line
triptans, NSAIDS
Abortive Treatment Second Line
NSAIDs
Prevention Treatment First Lines
monotherapy
valproate, topiramate, metoprolol, propranolol, frovatriptan