Migraine

Question 1

What is the pathogenesis for migraine. (3)

Answer 1

Exact pathogenesis is unknown.
Vasoconstriction?
Neurotransmitters?
Vasoactive substances?

Question 2

What is the ration of women:men affected by migraine.

Answer 2

2-3:1.

Question 3

What are the symptoms of migraine. (5)

Answer 3

Headache: throbbing, usually unilateral initially, becoming diffuse over 1-2h. 
Lasts up to 24h. 
Nausea/vomiting. 
Photophobia. 
Some have a preceding aura.

Question 4

What are the physical signs of migraine. (3)

Answer 4

Patients usually have a normal neurological examination.

Occasional sensory or motor deficits, visual deficits (eg scotoma, field defects).

Question 5

How are migraines usually diagnosed.

Answer 5

Usually diagnosed clinically.

Question 6

When must a migraine be further investigated. (2)

Answer 6

If the patient presents acutely to the emergency department for the first time.
Especially if they have neurological deficits (other causes must be excluded).

Question 7

What are the two treatments for migraines. (2)

Answer 7

Prophylactic treatment.

Acute attack treatment.

Question 8

What are the prophylactic treatments for migraine. (6)

Answer 8

Anti-epileptics. 
Beta-blockers. 
Amitriptyline. 
Selective serotonin reuptake inhibitor (SSRI). 
Antidepressants. 
Serotonin antagonists (eg methysergide).

Question 9

What is the treatment for acute attacks of migraine. (4)

Answer 9

Analgesics (paracetamol, NSAIDs, opioids).
Anti-emetics.
5-HT1 agonists (eg sumatriptan).
Ergot alkaloids (eg ergotamine).