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Final Notes > FN: Migraine > Flashcards

FN: Migraine Flashcards

1
Q

Epi

A

8% prev

F:M = 2:1

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2
Q

Risk factors

A

Obesity

PFO

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3
Q

Pathophysiology

A
  1. Vascular: cerebrovascular constriction - aura, dilatation - headache
  2. brain: spreading cortical depression
  3. Inflammation: activation of CN V nerve terminals in meninges and cerebral vessels
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4
Q

Triggers

A 
CHOCOLATE
Cheese
OCP
Caffeine
alcohOL
Anxiety
Travel
Excercise
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5
Q

Symptoms

A

Headaces
Prodrome
Aura

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6
Q

Headache types

A
  1. Aura lasting 15-30min then unilateral throbbing headache
  2. Phono/photophobia
  3. n/v
  4. Allodynia
  5. Often premenstrual
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7
Q

Prodrome (50%): preced migraine by hrs - days

A
  1. yawning
  2. Food cravings
  3. Changes in sleep, appetite or mood
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8
Q

Aura (20%): precedes migraine by mins and my persist

A
  1. visual: distortion, lines, dots, zig-zags, scotom, hemianopia
  2. Sensory: parasthesia (fingers - face)
  3. Motor: dysarthria, ataxia, ophthalmoplegia, hemiparesis (hemiplegic migraine)
  4. Speech: dysphasia, paraphasia
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9
Q

Classification

A
  1. Migraine with aura (classical migraine)

2. Migraine w/o aura (common migraine)

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10
Q

Diagnostic criteria

A
  1. Typical aura + headache, or
  2. > 5 headaches lasting 4-72h with either n/v or photo/phonophobia + >2 of:
  3. Unilateral
  4. Pulsating
  5. Interferes with normal life
  6. Worsened by routine activity
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11
Q

Differential

A
  1. cluster/tension headache
  2. Cervical spondylosis
  3. HTN
  4. Intracranal pathology
  5. Epilepsy
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12
Q

Treatment acute episode

A

1st: paracetamol + metoclopramide/doperidone
2nd: NSAID (e.g. ketoprofen) + M/D
3rd: rizatriptan - CI: IHD, uncontrolled HTN, SSRIs
4th: ergotamine

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13
Q

Prophylaxis

A

Avoid triggers

1st: propanolol, topiramate
2nd: Valporate, pizotifen (increased wt), gabapentin

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14
Q

Rule out diagnosis – Red flags

A 
Onset after 50 (migraine does not usually come on at this age)
Sudden onset (SAH)
Hx of cancer  metastesis
Progressivaly worsening over days (abcess/tumour?)
Waking patient at night (tumour)
Early morning vomiting (Raised ICP)
Unilateral loss of power (stroke)
Seizure (tumour)
Weight loss (tumour or cerebral TB)
Altered consciousness (meningitis)
Fever (meningitis)
Immunodeficiency
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15
Q

Exam

A 
Pulse and BP
Optic fundi (papiloedema warrants urgent admission)
Test for neck stiffness
Palpate scalpe for tenderness
Examine cranial nerves
Neuro exam on limbs
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16
Q

Management

A

• Reassure and relieve anxiety
• Avoid precipitating dietary factors
• Trial a different contraceptive
• Simple analgesia (overuse can lead to rebound)
• Anti-emetics (domperidone or metaclopramiede)
• Triptans
Accupuncture

17
Q

• Reassure and relieve anxiety
• Avoid precipitating dietary factors
• Trial a different contraceptive
• Simple analgesia (overuse can lead to rebound)
• Anti-emetics (domperidone or metaclopramiede)
• Triptans
Accupuncture

A
  1. Reassure
  2. Avoid dietary factors
  3. Try different COP
  4. NSAIDS
  5. Anti-emetics
  6. Triptans
  7. Acupuncture?
18
Q

Triptans advise

A

Sumitriptan is available over the counter 50 mg dosage

19
Q

when to consider prophylaxis

A

Prophylaxis is considered if >2 attacks per month or if attacks are particularly severe/prolonged

20
Q

Prophylaxis

firstline

A

Propranolol

21
Q

Prophylaxis second line

A

: Tricyclic or anti-epileptic drugs (sodium valproate or topiramate) are second line.

22
Q

Propranolol for the use

A

Proven efficacy

Also treats hypertension and anxiety

23
Q

Propranolol against the use

A

Contra-indicated by asthma and peripheral vascular disease

24
Q

Amitriptyliine for the use

A

Also treats insomnia and depression

25
Q

Amitriptyline against the use

A

Lack of evidence

Not licensed

26
Q

Sodium valproate S.E.

A

S.E: Nausea, tremor, dizziness and birth defects

27
Q

Topiramte for the use

A

Recent licence

Proven efficacy

28
Q

Topiramate against the use

A

S.E: paraesthesia, impaired concentration and sleep, weight loss
Affects efficacy of COP, progesterone only pill
Interacts with some other drugs

29
Q

Pizotifen against the use

A

S.E.: weight gain and sedation

Evidence limited

30
Q

Feverfew (Herbal remedy) for and against

A

Safe

Lack of evidence

31
Q

Botulinum toxin Type A

A

is recommended by NICE for the prevention of heads in adults with chronic migraine (experiencing headaches for at lest 15 days each month with migraine on at least 8 of these days) who have tried at least 3 other drugs to prevent migraine. It is given by im injection at multiple sites around the head and back of the neck every 12 weeks

32
Q

Foramen ovale closure?

A

At present NIE does not recommended routine percutaneous closure of patent foramen ovale for the prevention of migraine, because of the risks associated with this procedure

Final Notes (196 decks)

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