Migraine

Question 1

What are the three different kinds of auras?

Answer 1

Motor, sensory and visual

Question 2

What percentage of migraine patients experience auras?

Answer 2

33%

Question 3

What are the signs of motor auras?

Answer 3

Slurred or jumbled speech, difficulty understanding what others say, difficulty writing, problems thinking clearly.

Question 4

What are the signs of visual auras?

Answer 4

Flashing lights, zig-zagging lines, blurred vision, blind spots that expand over time.

Question 5

What are the signs of sensory auras?

Answer 5

Numbness or tingling

Question 6

What are the migraine phases?

Answer 6

Premonitory, Aura, Headache, Postdrome

these may overlap

Question 7

What is the old model of migraine?

Answer 7

Question 8

New theory?

Answer 8

Question 9

What is the aura pathophysiology?

Answer 9

• Cortical spreading depolarisation / fka„depression“ (CSD)
  * extreme depolarisation of glial and neuronal cell membranes
  * disruption of ionic gradients (incr. extracellular potassium)
  * glutamate release
• 2–6 mm/min, same speed as typical visual aura
• leads to tissue swelling in rodent models
• first increase then decrease in cerebral blood flow

Question 10

What are the mechanisms of the premonitory phase?

Answer 10

• Variation in cervical and trigeminal nerve anatomy
• pain inputs from the cervical nerves and trig. nerve converge on second-order neurons in the brainstem and upper cervical spinal cord
• stimulation of the cervical nerves triggers head pain in healthy individuals
• C1 stimulation in patients with migraine triggers pain in a peri-orbital distribution
• could influence the pattern of migraine pain
• target of localized therapies (nerve block)