migraine

Question 1

what are the three types of migraine

Answer 1

-migraine without aura
-migraine with aura
-atypical migraine

Question 2

cause of migraine without aura

Answer 2

-vascular and neural influences
-stress triggers changes in the brain which cause serotonin to be released
-blood vessels constrict and dilate
-chemicals including substance P irritate nerves and blood vessels causing pain

Question 3

cause of migraine with aura

Answer 3

-cortical spreading depolarisation in the migraine centre of the brain
-activation of the trigeminal vascular system causes dilation of blood vessels
-release of substance P, neurokinin A, CGRP

Question 4

presentation of migraine without aura

Answer 4

-unilateral throbbing headache
-4-72 hours
-at least 5 attacks
photophobia
-phonophobia
-may be triggers

Question 5

diagnostic criteria for migraine without aura

Answer 5

2 of: moderate/severe, unilateral, throbbing pain, worst on movement
1 of: autonomic features, photophobia/phonophobia

Question 6

presentation of migraine with aura

Answer 6

-unilateral throbbing headache preceded by an aura, such as a visual or sensory symptoms (lines, zig zags, paraesthesia spreading from fingers to face)
-aura fully reversible
-aura lasts 20-60 mins
-headache follows <1 hour later but aura can occur simultaneously

Question 7

presentation of an atypical migraine

Answer 7

-acephalgic (no headache)
-basilar (nausea and vertigo)
-retinal, opthalamic
-hemiplegic
-abdominal

Question 8

pharmacological management of acute migraine

Answer 8

-NSAID
-if gastroparesis then anti-emetic
-triptans

Question 9

when should you consider prophylactic treatment

Answer 9

if more than 3 attacks per month or very severe attacks

Question 10

prophylactic treatment

Answer 10

-amitriptyline, propanolol, topiramate
-acupuncture