MIGRAINE

Question 1

What type of headache are migraines classified as?

Answer 1

chronic primary

Question 2

pathophysiology of migraines?

Answer 2

unknown but likely due to neuronal dysfunction

Question 3

when does the prodrome of a migraine occur and what are some examples of what a pt may experience?

Answer 3

24-48 hours prior to onset of migraine.
euphoria, depression, irritability, food cravings, neck stiffness.

Question 4

when does the aura of a migraine develop? what kind of sx might a pt experience?

Answer 4

5-60 minutes prior to headache.
positive sx - visual, auditory, somatosensory
negative sx - loss of vision, heading, feeling, or function

Question 5

describe the clinical features of a classic migraine

Answer 5

usually unilateral and pulsatile. associated with N/V, photophobia, or phonophobia.
has a prodrome, aura, and postdrome.

Question 6

what are the ICHD-3 criteria for diagnosis of a migraine?

Answer 6

at least 5 attacks, lasting 4 - 72 hours.

at least 2 of: unilateral, pulsatile, mod/severe intensity, worsened by physical activity.

during HA, at least one of:
-Nausea, vomiting, or both;
-Photophobia and phonophobia

Question 7

what are the ICHD-3 criteria to add qualification of “with aura” to a migraine diagnosis?

Answer 7

at least 2 attacks.

one or more of the following reversible aura sx: visual, sensory, speech, motor, brainstem, retinal.

at least 3 of:
- 1+ aura sx spreads gradually over 5+ minutes
- 2+ sx occur in succession
- each aura sx lasts 5-60min
- 1+ aura sx is unilateral
- 1+ aura sx is positive
- aura accompanied/followed by HA within 60min

Question 8

what is the symptomatic therapy for migraine?

Answer 8

simple analgesics (tylenol, NSAID).

if fails, then triptans (sumatriptan subQ, or zolmitriptan, or rizatriptan).

if fails, then naproxen-triptan combo.

Question 9

what is the symptomatic therapy for a pt with migraine and N/V?

Answer 9

subQ sumatriptan + IV reglan or compazine + IV benadryl

can add IV/IM dexamethasone to reduce risk of early HA recurrence (but does nothing for current HA).

Question 10

what is the goal of migraine symptomatic therapy ?

Answer 10

prevent medication overuse.
use of simple analgesics less than 15 days/month.
use of combo analgesics and triptans for less than 10 days/month.

Question 11

when should preventive therapy for migraines be considered?

Answer 11

when migraines occur more often than 4x per month;
or when they last longer than 12 hours;
or when they are associated with significant disability

Question 12

what are some drugs for preventive therapy of migraines?

Answer 12

antiepileptics (topiramate, valproic acid, gabapentin)

cardiovascular drugs (candesartan, propranolol, timolol, verapamil)

antidepressant (amitriptyline)

Question 13

what are some “other” preventive therapies for migraines?

Answer 13

[these are usually used as adjunct therapies]

avoid/manage triggers!
botox
Magnesium
acupuncture
transcutaneous supraorbital nerve stimulation
occipital nerve block/decompression
biofeedback