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Neuroanatomy 2 > Migraine > Flashcards

Migraine Flashcards

1
Q

What are some key differences between a tension headache and a Migraine?

A

Tension: Bilateral, non-throbbing, rarely disabling, featureless

Migraine: Often throbbing, associated photo and phono phobia, nausea, disabling

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2
Q

Features of a tension headache

A

Common in the general population, RARE as a chief complaint

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3
Q

What is the prevalence of migraine amongst canadians and at what age does it peak?

A
  1. > 4 milion Canadians
    2) 3:1 women:men
    3) 25-55 years of age
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4
Q

Prevalence of primary headaches in school children

A

10-20% in school children (boys more than girls)

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5
Q

Prevalence of primary headaches in adolescents

A

~30% 1x/month

~90% 1x/year

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6
Q

Migraine headaches in children 7 years of age

A

1-3%

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7
Q

Migraine in 15 years of age

A

4-20%

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8
Q

Migraine is more common than what two diseases?

A

1) Asthma

2) Diabetes - combined

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9
Q

Migraine features

A
  1. Neurological, with strong genetic component
  2. Overal >10% global prevalence (more women)
  3. 2 subtypes (+/- aura)
  4. world’s 20 most disabling diseases (3 million women, and 1 million men)
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10
Q

Why is there a higher prevalence of migraines in women?

A
  1. Hormonal factors, including sudden increase in E2 at menstruation
  2. Gender difference after menopause suggests other factors involved
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11
Q

How do you define Migraine?

A

Episodic headache disorder

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12
Q

What might chronic headaches be a sign of?

A

Depression, anxiety, sleep disorders

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13
Q

Signs of a migraine without aura…

A 
5 attacks of 
1) lasting 4-72 hours
2) - unilateral location (although 40% are bilaterally), pulsating quality (50% are non pulsating), moderate or severe pain, aggravation by avoidance of physical activity
>= 1 of the following
3) Nausea/vomiting or photo/phonophobia
4) not attributed to other disorder
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14
Q

Signs of a migraine WITH aura…

A

2 attacks of
1) Fully reversible visual/sensory/speech symptoms - no motor weakness
at least 2 of the following
1. unilateral symptoms that develop gradually over 5 min, at 2. least one symptom developing gradually over 5 mins
3. each symptom lasting >5 mins, <60 mins
3) migraine begins with aura or follows within 60 min

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15
Q

What is an aura?

A

1) at least 2 attacks
2) fully reversible symptoms
3) (2 of…)unilateral snesory, develops gradually, duration >5 min, s visual, must last at least 5 mins.. BLURRY VISION NOT AN AURA

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16
Q

International classification of headache disorders (2 + 1)

A

any 2 of

  • unilateral
  • throbbing
  • worsened by activity
  • moderate or severe

any 1 of

  • nausea/vomiting or anorexia!
  • photo phonophobia
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17
Q

4 phases of a migraine attack.

A

1) prodrome
2) headache
3) resolution (sensory hyper excitability)
4) postdrome

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18
Q

When does the prodrome phase occur?

A

12-24 hours before headache - can be fatigue, mood swings, excessive yawning, food cravings, driven by Dopamine!

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19
Q

What are common triggers of a migraine?

A

1) weather changes
2) poor sleep
3) weekends and holidays
4) menstrual cycle
5) strong smells
6) stress
7) fasting/skipping meals
8) certain foods - MSG, wine, caffeine

20
Q

Vascular theory of migraine - suggests 2 things

A

1) AURA: caused by vasoconstriction (but vessels are normal)

2) THROBBING: due to vasodilation (but they are not dilated till later)

21
Q

what is the primary cause of migraines?

A
  1. Genetic predisposition
  2. cortical neuronal hyper excitability and/or brainstem dysfunction
  3. Cortical spreading depression
  4. Activation and sensitization of trigeminal vascular system
  5. prolonged headache pain
22
Q

What is migraine commonly misdiagnosed as?

A 
(SECONDARY headache is sinus not primary) 
Sinus headache (face pain, worse lying down, associated nasal discharge)
23
Q

What else is migraine commonly misdiagnosed as?

A 
Tension type headache - 
In migraine 
neck pain (75-80%), more prevalent than nausea, stress is a trigger, 40% migraines are bilateral
24
Q

Medication overuse headaches are common with what type and frequency of meds?

A

~2% prevalence

  1. Acetaminophen, Ibf, anything with caffeine - 2 days/week
  2. codeine narcotics - 5-8 doses/month
  3. triptans 10 days/month
25
Q

What do patients want?

A 
Complete relief (even with side effects)
Oral tablet
26
Q

Acute migraine medications

A

1) Triptans - 5HT B/D (serotonergic) receptor agonists (effective early, contraindicated with vascular risk factors)
2) Dihydroergotamine
3) nonspecific - NSAIDS, corticosteroids, antiemetics

27
Q

Who gets a triptan?

A

1) Episodic and disabling migraine complaints

2) Absence of vascular contraindications

28
Q

Safety of triptans, what are some problems?

A

1) Triptan sensations - chest pressure
2) CNS effects, dizziness, fatigue, somnolence
3) serotonin syndrome (very rare) - activates 5HT 2a not 1B/D/F

CV disease, uncontrolled HTN (CONTRAINDICATION)

29
Q

What is serotonin syndrome?

A

Activation of the 5HT2a receptor (triptans activate BDF receptors)

30
Q

Why do you treat migraines early?

A

The Central Trig vascular neurone become sensitized within 1 HOUR
central sensitization gives rise to cutaneous allodynia - pony tail painful, skin irritated/bothere - happens within one hour
Incomplete response once that develops!

31
Q

How are headaches classified

A
  1. Primary - symptomatic based

2. Secondary - etiology based

32
Q

Which is more prevalent a migraine with or without aura?

A

Without (75% vs 25% with)

33
Q

which neurotransmitter may be involved in chronic headache/depression

A

lack of serotonin

34
Q

WHat % of headaches go from episodic to chronic?

A

3%

35
Q

What are the two most RELIABLE factors in diagnosing migraine without aura?

A

1) moderate to severe pain

2) difficulty to do physical activity

36
Q

What is sensory hyper excitability?

A

Inherited component of a migraine, may have something to do with enhanced survivability

37
Q

What are some co-existing disorders with Migraines?

A
  1. IRRITABLE BOWER SYn
  2. Anxiety
  3. depressed mood
  4. poor sleep
    SEROTONIN PLAYS A KEY ROLE - large amount in gut
38
Q

What are some childhood variants of migraines?

A
  1. cyclical vomiting
  2. sleep walking
  3. recurrent abdominal pain
  4. INFANT COLIC
  5. motion sickness
39
Q

How is migraine caused?

A
  • triggered in brainstem
  • cortical spreading depression forward moving -
    reduction in blood flow - migrates across cortex - doesn’t follow blood flow and cells are extracting less oxygen from blood (AURA)
  • this activates the trigeminal vascular system - messages go through trigeminal nucleus caudalis then sent cortically through thalamus
40
Q

what is a true sinus headache?

A
  1. Face pain
  2. worse lying down
  3. associated with nasal discharge and fever
41
Q

which molecular is important to think about with respect to inflammation?

A

CGRP

42
Q

The trigeminal nerve description of migraines confuses diagnosis…..

A
  1. head and facial pain can be bilateral
  2. Neck pain (cervical nerve interactions)
  3. Sinus symptoms
43
Q

when do you have an incomplete response to triptans?

A

Once cutaneous allodynia develops

44
Q

What is the goal of preventative headache?

A 
NOT TO BE HEADACHE FREE
Reduce headache by 50% 
reduce acute med use
increase effectiveness
prevent chronicity
45
Q

How does Botox work for migraine?

A

BLOCKs CGRP

Neuroanatomy 2 (25 decks)

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