Headache (Migraine)- Patho, Diagnosis, Symptoms

Question 1

Phases of a migraine

Answer 1

Premonitory phase, aura, headache pain phase, postdrome

Question 2

Symptoms of the premonitory phase

Answer 2

Tiredness, mood changes, yawning, thirst, cravings, urinary frequency, light and sound sensitivity, cranial autonomic symptoms: conjunctival injection, tearing, rhinorrhea, flushing, sweating

Question 3

Aura phase

Answer 3

Cortical spreading depression

Question 4

Headache pain phase symptoms

Answer 4

Throbbing headache, N/V, light, sound, and smell sensitivity

Question 5

How long does the premonitory phase last?

Answer 5

Hours to days before the onset of the migraine

Question 6

How long does the headache pain phase last?

Answer 6

4-72 hours

Question 7

Postdrome phase symptoms

Answer 7

Tiredness, difficulty concentrating

Question 8

How long does the postdrome phase last?

Answer 8

Up to 48 hours after the migraine ends

Question 9

Premonitory phase patho

Answer 9

Hypothalamus, brainstem, limbic system, cortical areas are triggered by alterations in homeostasis –> increased parasympathetic activity –> activates meningeal nociceptors

Question 10

What affects nociceptive signals?

Answer 10

Cyclical brainstem activity

Question 11

Headache pain phase patho: what neuropeptides are involved?

Answer 11

CGRP, PACAP-38

Question 12

Headache pain phase patho

Answer 12

Trigeminovascular system activation, cortical spreading depression, sensitization, neuronal hyperexcitability

Question 13

Migraine triggers

Answer 13

stress, hormone changes/menstruation, not eating, weather, sleep disturbance, perfume/odor, neck pain, bright lights, alcohol, smoke, sleeping late, heat, food, exercise, sexual activity

Question 14

Diagnostic criteria for a migraine without aura

Answer 14

Headache attacks lasting 4-72 hours (when untreated or successfully treated)

Headache has at least 2/4 characteristics:
Unilateral location
Moderate or severe pain intensity
Aggravation by or causing avoidance or routine physical activity like walking or climbing up stairs

During headache, at least 1 of the following:
Nausea and/or vomiting
Photophobia and phonophobia

Question 15

Diagnostic criteria for migraine WITH aura

Answer 15

≥1 of the following fully reversible aura symptoms
Visual, sensory, speech and/or language, motor, brainstem, retinal

At least 3/6 characteristics:
At least 1 aura symptom spreads gradually over ≥5 minutes
≥2 aura symptoms occurring in succession
Each individual aura symptom lasts 5-60 minutes
≥1 aura symptom is unilateral
≥1 aura symptom is positive
Aura is accompanied, or followed within 60 minutes, by headache

Question 16

Diagnostic criteria for a chronic migraine

Answer 16

Occurring in a patient who’s had at least 5 attacks fulfilling criteria B-D for MIGRAINE WITHOUT AURA and/or criteria B and C for MIGRAINE WITH AURA

On ≥8 days/month for >3 months, fulfilling any of the following:
Criteria C and D for MIGRAINE WITHOUT AURA
Criteria B and C for MIGRAINE WITH AURA

Believed by the patient to be migraine at onset and relieved by a triptan or ergot derivative

Question 17

Characteristics of a migraine

Answer 17

Positive visual symptoms
Gradual onset/evolution
Sequential progression
Repetitive attacks of identical nature
Flurry of attacks midlife
Duration <60 minutes
Headache follows about 50% of the time

Question 18

Characteristics of a TIA

Answer 18

Visual loss, abrupt onset, simultaneous occurrence, duration <15 minutes, headache uncommon accompaniment