Migraine Flashcards
what is the most common cause of episodic headache?
migraine
different types of migraines?
-Migraine without aura
-Migraine with aura
-Atypical :
* Acephalgic - no headache
* Basilar - very nauseating, vertigo
* Retinal, opthalmic
* Hemiplegic (familial/sporadic)
Abdominal - more common in young children
examples of atypical migraines
- Acephalgic - no headache
- Basilar - very nauseating, vertigo
- Retinal, opthalmic
- Hemiplegic (familial/sporadic)
Abdominal - more common in young children
are migraines more common in males or females?
females
what are some common triggers for migraines?
-sleep
-diet
-stress
-hormonal (e.g. oral contraception)
-physical exertion
what may be useful in helping figure out specific migraine triggers?
-headache diary
what criteria is used to determine if someone has a migraine without aura?
IHS criteria
* At least 5 attacks
* 4-72 hours
* 2 of: moderate/severe, unilateral, throbbing pain, worst movement
* 1 of: autonomic features, photophobia/phonophobia
what is most common form of migraine?
migraine without aura (80%)
(migraine with aura is 20%)
how long does aura in a migraine typically last?
20-60 mins
when does a headache usually follow the aura in a migraine with aura?
the headache usually follows <1 hour later but the aura can occur simultaneously
how does a migraine typically present?
-a unilateral pounding, throbbing headache which may be preceded by an aura, such as visual (e.g. lines, zigzags) or sensory (parasthesia) symptoms
-headache may last 4 to 72 hours and is associated with photophobia and phonophobia
how long does a typical migraine last?
4-72 hours
what is the non pharmacological management for migraines?
- Set realistic goals
- Education- avoid triggers
- Headache diary
-Relaxation/ stress management
what is acute pharmacological management for migraine?
-NSAID (aspirin, naproxen, ibuprofen) (+ an anti emetic if patient has gastroperesis)
-Triptans (5HT agonist) e.g. rizatriptan, eletriptan, sumatriptan
NSAIDs to be taken as early as possible
Triptans to be taken at the start of a headache
when should prophylaxis medication be considered for migraine?
consider if patient is:
-experiencing more than 3 attacks per month
or
-very severe attacks
what drugs may be taken for prophylaxis of a migraine?
-amitriptyline (1st line)
-propanolol (1st line)
-topiramate (2nd line)
go slow and keep low!
and trial each drug for minimum 3 months
contra indication of propanolol?
asthma
PVD
heart failure
SE and contraindication of topiramate?
CI: woman of child bearing age
SE: weight gain, paraesthesia, impaired concentration
what are some non pharmacological methods of prophylaxis for migraines?
-acupuncture
-relaxation exercises
pathophysiology behind a migraine without aura?
- Both vascular and neural influences cause migraines in susceptible individuals
- Stress triggers changes in the brain which cause serotonin release
- Blood vessels constrict and dilate
-Chemicals including substance P irritate nerve and blood vessels causing pain
→ Increased sensitivity
* In both cases, the chemicals result in the sensitization of trigeminal neurones and brainstem pain pathways
-This makes otherwise innocuous sensory stimuli (such as CSF pulsation and head movement) painful, and light and sound are perceived as uncomfortable
what is the pathophysiology behind a migraine with aura?
- Cortical spreading depolarisation in the migraine centre of the brain (dorsal raphe nucleus, locus coeruleus)
- Activation of the trigeminal vascular system causes dilation of blood vessels
-Release of substance P, neurokinin A, CGRP
→ Increased sensitivity
* In both cases, the chemicals result in the sensitization of trigeminal neurones and brainstem pain pathways
-This makes otherwise innocuous sensory stimuli (such as CSF pulsation and head movement) painful, and light and sound are perceived as uncomfortable
what are red flags for a headache?
!!RED FLAGS!!
* New onset headache > 55
* Known/ previous malignancy
* Immuno suppressed
* Early morning headache
-Exacerbating by valsalva
amitriptyline common SE?
-dry mouth
-postural hypotension
-fatigue/ sedation
