Introduction to migraine (DECK NEEDS IMPROVING) Flashcards
1
Q
What are the five stages of migraine?
A
- Prodromal. Early symptoms: Mood changes, Fatigue Cognitive changes, Food craving, Repetitive yawning, Neck stiffness. Aura: Fully reversible neurological changes of various severity.
- Mild headache pain
- Moderate headache pain
- Severe headache pain
- Postdromal.
2
Q
What are the key brain regions activated prior to migraine onset?
A
Hypothalamus
Brainstem - PAG
3
Q
Non specific pharmacological acute migraine treatments
A
- paracetamol
NSAIDS:
- Ibuprofen
- Naproxen
- Tolfenamic acid
-Opioids
4
Q
Specific pharmacological acute migraine treatments
A
- Erogotamine & Derivatives: Vasoconstrictive. No longer used as peoples fingers fell off.
- Triptans: 5HT1IB/D agonists
5
Q
Where are 5HT1B/D receptors localized?
A
- On neurones innervating the vasculature
- Diencephalic and brain stem nuclei
- Central neurons within brainstem
6
Q
What is the mechanism of action of triptans?
A
- Block neurotransmission in neurons innervating vasculature
- Block transmission within the trigemniocervical complex
- May block CGRP transmission
7
Q
What are the thresholds for medication overuse in triptans and NSAIDS, and what are the proposed mechanisms?
A
- Headache on more than 15 days per month.
- Combined with the regular overuse of acute medication for more than 3 months: – Triptans: 10 days per month – NSAID’s: 15 days per month
- Sensitization due to upregulation of 5HT1D and CGRP within the brain
8
Q
What is the mechanism of action of botox for migraine treatment?
A
Injected at the same sites as cosmetically used
Cleaves SNAP/SNARE proteins to prevent vesicle docking and neurotransmission
9
Q
What are some non-pharmalogical tratments of migraine?
A
Transcranial magnetic stimulation
