Migraine

Question 1

Define: migraine

Answer 1

A typical migraine attack consists of a unilateral, throbbing headache accompanied by photophobia, phonophobia, nausea and disability

Question 2

What is the etiology of migraines

Answer 2

Internal causes:
- Genetic: 60%
- Endocrine factors:
M:F (1:2)
*onset age is usually during early childhood/adolescence
*occur before/during menses and reduces during pregnancy or after meopause

External causes:
- food (thyramine containing cheese, meat containg nitrate, monosodium glutamate addidative)
- drugs (nitroglycerine, oral contraceptives)
- bright lights, emotional/physical stress, lack of sleep, missed meals or menstruation

Question 3

What is the pathogenesis of migraines

Answer 3

1. vascular theory:
   intracranial vasoconstriction leads to aura. intracranial and extracranial vasodilation leads to headache phases of migraine.
2. neural theory:
   the aura is due to cortical spreading depressing. a reduction in regional flow begins in occipital region and the towards adjacent cortex with 2-5mm/min during aura phase

Question 4

Clinical manifestation of migraine with Auras

Answer 4

Aura: typically characterised by any combination of visual hemisensory or language abnormalities with each symptom developing over at least 5 minutes and lasting a maximum of 60min
- most common is visual aura
Headache: during or within 60min of aura. Pulsating quality. hemicranial pain is most common by pain can also be bifocal or unilateral frontal in distribution
- nausea, vomiting, photophobia, phonophobia, irritability, vertigo, ataxia

Question 5

Clinical manifestation of migraine without aura

Answer 5

most frequent type of migraine (+80%)
symptoms are similar to other migraine just without aura

Question 6

Differential diagnosis for migraine

Answer 6

1. Tension-type headache:
   -bilateral lasting 30min to 7 days
   - non pulsating, pressing or tightening quality is described by patients as band-like constriction around head
   - attacks are mild to moderate in intensity, do not prohibit activity and are no agrivated by routine activity
   - no association with nausea and vomiting

Question 7

Treatment of migraine

Answer 7

• avoidance of precipitaing factors
• rest in quiet, dark room until syptoms subside

*mild-moderate migraine: mild analgesics
*mild-moderate with no vomiting or severe nausea: acetominophen, aspirin or combined analgesic
*NSAIDS in adequate amounts

Calcium channel blockers may decrease frequency of attacks after an interval of several weeks –> severity and duration is unaltered