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Onco/Neuro > Migraine > Flashcards

Migraine Flashcards

1
Q

Describe the difference between tension, cluster, sinus and migraine headaches

A

Tension- caused by light muscles in shoulders, neck, scalp or jaw. Feels like a tight band squeezing the head

Cluster- comes without warning and begins in the eye on one side only. Pain may feel like a stabbing sensation in the eye. Short attacks 15min-3h

Sinus- result from a build up of pressure within the sinuses of the skull. Pain is centered behind the forehead and cheekbones

Migraine- caused by changes in the brain and blood vessels. Classic symptoms include: pain, n+v, visual changes

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2
Q

What are the treatment options for tension type headaches?

A

Cognitive behaviour therapy and relaxation therapy
Physical therapy- massage/accupuncture
Pharmacological- analgesics +/- caffeine

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3
Q

What are common triggers for cluster headaches?

A 
Stress
Extreme temperatures
Glare
Allergic rhinitis
High attitude
Alcohol
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4
Q

Acute treatment options for cluster headaches? (2)

A

High flow oxygen inhalation therapy

Triptans- injection/nasal spray more effective than tablet

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5
Q

Three cluster headache preventive medications?

A
  1. Verapamil
  2. Corticosteriods
  3. Antiseizure medication
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6
Q

What are some features of migraines? (4)

A
  1. Headaches that last 4-72 hours
  2. At least 2 of: unilateral pain, throbbing pain, mod-severe intensity pain, aggravation of pain by routine movement
  3. During the headache: nausea, vomiting, photo or phono phobic can occur
  4. Some people can experience auras on top of this (migraine with aura)
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7
Q

Internal triggers for migraine? (4)

A
  1. Hormonal
  2. Emotions
  3. Sleep (deprivation/sleeping in)
  4. Physical exercise
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8
Q

External triggers for migraine? (6)

A
  1. Weather changes
  2. Alcohol
  3. Diet
  4. Bright lights
  5. Strong odours
  6. Caffeine or caffeine withdrawal
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9
Q

How do mutations affect excitability?

A

Increase the concentration of glutamate and K+ in the synaptic cleft, making the brain more susceptible to cortical spreading depression.
Affects Ca2+ channel, Na/K pump, Na channels

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10
Q

What role does CSD play in causing migraines?

A

Cortical spreading depression is like the passing of a thunderstorm.
A wave of increase electrical activity starts out in the occipital cortex (aura if surface cortex is affected)
After the wave, the area behind is depressed (scotoma)

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11
Q

What causes CSD?

A
  1. Triggers from meninges and peripherial blood vessels activate the trigeminal nerve and trigeminal nucleus
  2. Hypersensitivity or malfunctioning neurons in brainstem or PAG
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12
Q

What is CGRP and how is it related to migraines?

A

Calcitonin gene related peptide

Causes the release of local inflammatory mediators such as vasodilation, throbbing sensation, pain with head movements

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13
Q

List some non pharmacological treatments for migraine (6)

A
  1. Avoid triggers
  2. Diet (caffeine, avoid processed foods, preservatives, hydration)
  3. Sleeo
  4. Exercise
  5. Reduce stress (relaxation therapy, mediation)
  6. Anti teeth clenching device
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14
Q

5 treatment options for acute migraine?

A

First line

  1. NSAIDs
  2. paracetamol (aspirin 900mg, ibuprofen, naproxen, diclofenac)
  3. Antinauseants (maxolon, stemetil)

Second line

  1. Serotinin (5HT 1b/1d) receptor agonist
  2. Ergot alkaloids
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15
Q

List 5 Serotinin (5HT 1b/1d) receptor agonist

A
  1. Sumatriptan (imigran)
  2. Naratriptan (naramig)
  3. Eletriptan (relpax)
  4. Rizatriptan (maxalt)
  5. Zolmitriptan (zomig)
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16
Q

How do triptans work?

A

Agonist at 5-HT 1b/1d receptors to inhibit neurogenic inflammation and intracranial blood vessel constriction.
(Decrease of inflammatory mediators and CGRP)
CNS: decrease activity of pain neurons from brainstem to cortex
Peripherally: Decrease vascular inflammation, release of infammatory mediators in meninges, transmission of pain from periphery trigeminal nerves to brainstem

17
Q

Prophylactic drugs for migrains?

A
  1. B-blockers (propanolol, metoprolol, atenolol) - first line
  2. Pizotifen
  3. Methysergide (deseril)
    4, TCA
  4. Antiepileptics (valproate, topiramate) - second line
  5. Ca channel blockers
18
Q

When is the best time to take triptans?

A

When the headache is beginning to develop, not earlier or later. ie: after aura has occured

19
Q

What are some common side effects of triptans?

A

Fast heartbeat, warm sensations, chest symptoms, fatigues

serotonin syndrome (rare), watch out if on other serotonin meds

20
Q

Practice points for migrains?

A
  1. Educate patient
  2. Diary
  3. Use migraine specific agents in patients with severe migraine and those who respond poorly to analgesics
  4. Abortive treatment are more effect if given early
  5. Nasal/ wafer available for patients prone to n+v
  6. Medication overuse headache

Onco/Neuro (7 decks)

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