Migraine Flashcards
What is primary vs. secondary classification of headache
Primary: symptom based
Secondary: etiology based
what are primary headaches
hundreds: tension, migraine, cluster etc
what is most common headache and most common physician visit headache
most common: tension
most visited: migraine
prevalence and sex of migraine
4 million canadians - 3:1 women:men
when is migraine peak
25-55 years
2 major subtypes of migraine
- without aura (75%)
2. with aura
why may women be more effected
estradiol decrease at menstruation may play a role, but not only factor
what is problem with episodic headache and how often
if not treated, can become chronic – 3% each year
7 modifiable risk factors for chronic migraine
- attack frequency
- obesity
- med overuse (>2/wk)
- stress response
- disordered sleep
- dep/anx
- allodynia
what are migraine without aura crit
A. 5 attacks fulfilling B-D
B. headaches lasting 4-72 hrs
C. 2 of: unilateral, pulsating, mod to severe pain, agg by activity
D. 1 of nausea/vomiting, photophobia/phonophobia
migraine with aura crit
same as without but:
B. reversible sensory or speech Sx
C. 2 of unilateral Sx, 5 minute development, 5-60 minutes Sx
what is contraindication of aura
birth control pill
what is IC headache classification
any 2: unilateral, throbbing, worsened by act, mod or severe
+1: nausea or vomiting, photo or phonobia
what is migraine prodrome
12-24hrs before - mood swings, choc cravings, yawning
co-existing disorders (4)
- IBS
- anxiety,
- depression
- poor sleep
common triggers
- weather
- poor sleep
- weekend/holidays
- menses
- strong smells
- stress
- skipping meals
what is migraine patho (5)
- genetic predisp
- cortical neuronal hyperexcitability
- cortical spreading depression
- trigeminovascular system activated
- prolonged headache pain of migraine
3 keys to true sinus headache
- face pain
- worse lying down
- discharge/fever
what is med overuse headache prev
1.5%
what are meds overused
- tylenol, ibuprofen – +2days/wk
- codeine, narcos, 5-8 doses/month
- triptans - 10days/month
what do patients want in a medication
- complete releif
2. pill form
what are 3 components to treatment
- education
- lifestyle mod
- vitamins/herbal
3 steps to med mgmt
- intial therapy
- if fail - back-up
- if fail - rescue
what is specific MOA drug
triptans - 5HT 1B/D - most effective early
what are non-specific
- NSAIDs
- analgesics
- corticosteroids
- antiemetics
what are tripan SEs
- most mild -chest pressure, CNS effects
2. serotonin syndrome - rare
what are 5 goals of preventative therapy
- not to be headache free
- reduce headaches by 50%
- reduce acute meds
- increase acute med effectivemness
- prevent chronification of headaches
