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INTERNAL MED 3+ conditions > Migraine > Flashcards

Migraine Flashcards

1
Q

Define migraine

A

Chronic, genetically determined, episodic neurological disorder that usually presents early-to-mid life

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2
Q

Symptoms associated with migraine

A
  • Nausea
  • Photophobia
  • Disability
  • Headache
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3
Q

Epidemiology migraine

A
  • Highly prevalent condition
  • 14% prevalence
  • M < F
  • Incidence rises through early adulthood - then declines in late 40s/early 50s
  • Highest prevalence in Caucasians
  • Decreases QoL and productivity
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4
Q

Migraine aetiology

A
  • Due to a hyperexcitable brain to a variety of stimuli

- Neuronal depolarisation is more easily triggered

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5
Q

What is cortical spreading depression

A

Self-propergating wave of depolarisation that spreads across the cerebral cortex

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6
Q

4 stages of a migraine

A
  1. Prodrome
  2. Aura
  3. Headache
  4. Postdrome
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7
Q

Discuss migraine prodrome

A
  • Experienced by 77% of people with migraines
  • Affective or vegatative symptoms 24-48 hours prior to onset of headache
  • Yawning
  • Irritability
  • Euphoria
  • Food cravings
  • Neck stiffness
  • Depression
  • Constipation
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8
Q

Describe migraine aura

A
  • Experienced by 25% of people with migraine
  • Occurs before and during headache
  • Gradually develops
  • <1 hour
  • Positive and negative features
  • Completely reversible
  • Symptoms = visual (most common), auditory, somatosensory, motor
  • Some people experience aura without headache
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9
Q

Describe a migraine headache

A
  • Usually unilateral
  • Throbbing/pulsatile
  • Increases with severity –> nausea and vomiting follow
  • Osmophobia - fear of odours
  • Cutaneous allodynia - pain to normal stimuli
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10
Q

What is cutaneous allodynia

A

Pain to normal stimuli

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11
Q

Describe migraine postdrome

A
  • Sudden head movement transiently causes pain in the location of the antecedent headache
  • Feel drained and exhausted
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12
Q

Migraine precipitating factors

A
  • Emotional stress
  • Female hormones
  • Not eating
  • Weather
  • Sleep disturbance
  • Odour
  • Neck pain
  • Lights
  • Alcohol
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13
Q

3 large classification groups for migraine

A
  1. Migraine without aura
  2. Migraine with aura
  3. Chronic migraine
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14
Q

Subgroups of migraine with aura

A
  • Typical aura
  • Brainstem aura - no motor weakness
  • Hemiplegic - motor weakness - familial (T1,2,3) or sporadic
  • Retinal - monoocular disturbances
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15
Q

Name of the clinical diagnosis for migraine

A

ICHD-3 (international classification of headache disorders)

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16
Q

Migraine diagnosis history

A
  • Headaches 4-72 hours

- Associated symptoms

17
Q

Tests for migraine

A

Usually tests of exclusion - no definitive test

  • MRI with contrast
  • Vascular imaging
  • Bloods
  • Lumbar puncture
18
Q

Tests of exclusion - migraines - more serious things - SNOOP4

A
  • Systemic
  • Neuro
  • Onset
  • Older
  • Pattern change
  • Papilloedema
  • Precipitating factors
  • Positional aggravation
19
Q

What happens to ESR in migrains

A

Normal

abnormal in temporal arteritis

20
Q

Testing for migraines and LP is abnormal

A
  • SAH

- Meningitis

21
Q

DDX for migraines

A
  • Tension or cluster headache
  • Medication overuse
  • Post-traumatic
  • SAH
  • Cerebral neoplasm
  • Low pressure headache
  • CNS infection
22
Q

ICHD-3 criteria for migraine without aura and with aura

A
  • > 5 attacks
  • Headache >4-72 hours
  • Headache - unilateral, pulsatile, moderate to severe intensity, aggravated on activity (2+)
  • N/V or photophobia/phonophobia
  • Not other diagnosis

WITH AURA - reversible symptoms of aura

23
Q

Migraine management and treatment

A
  • Symptom relief - NSAID, aspirin, anti-emetic, hydration, paracetamol
24
Q

Migraine prevention

A
  • CBT
  • Anticonvulasants - Valproate, Topiramate
  • TCAs
  • Beta-blockers
25
Q

Migraine prognosis

A
  • Responds well to treatment

- Frequency of episodes decreases with age

26
Q

Migraine complications

A
  • Status migrainosus
  • Migrainous infarction
  • Migraine triggered seizure
  • Depression
27
Q

What is status migrainosus

A

Migraine episode lasting >72 hours - debilitating

INTERNAL MED 3+ conditions (18 decks)

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