migraine

Question 1

several types of migraine

Answer 1

migraine w/o aura
migraine w aura
silent migraine
hemiplegic migraine

Question 2

typical features

Answer 2

lasts 4-72hrs
pounding/throbbing
unilateral
photophobia
phonophobia 
\+/- aura
N+V

Question 3

aura

Answer 3

visual changes assoc q migraine

• sparkes
• blurring
• lines
• loss visual fields

Question 4

heimplegic migraines

Answer 4

can mimic stroke

• usual migraine features
• hemiplegia
• ataxia
• alt consciousness

Question 5

triggers

Answer 5

stress
bright lights
strong smells 
chocolate
caffeine
dehydration 
menstruation 
abnormal sleep patterns
trauma

Question 6

5 stages

Answer 6

1. prodromal
2. aura
3. headache
4. resolution
5. postdromal

Question 7

Acute management

Answer 7

triptan + paracetomol
triptan + NSAID

antiemetic - metoclopramide

Question 8

triptans

Answer 8

used to abort migraines

5HT receptor agonists

Question 9

triptans - what to they act on

Answer 9

• arterial smooth muscle to cause vasoconstriction
• peripheral pain receptors to inhibit activation
• reduce neuronal activity in CNS

Question 10

when is migraine prophylaxis offered

Answer 10

2+ attacks per month

Question 11

migraine prophylaxis

Answer 11

propanolol

topiramate - teratogenic so dont use in pregnancy