Migraine Flashcards
Define migraine
Chronic, genetically determined, episodic neurological disorder that usually presents early-to-mid life
Symptoms associated with migraine
- Nausea
- Photophobia
- Disability
- Headache
Epidemiology migraine
- 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
Migraine aetiology
- Due to a hyperexcitable brain to a variety of stimuli
- Neuronal depolarisation is more easily triggered
What is cortical spreading depression
Self-propergating wave of depolarisation that spreads across the cerebral cortex
4 stages of a migraine
- Prodrome
- Aura
- Headache
- Postdrome
Discuss migraine prodrome
- 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
Describe migraine aura
- 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
Describe a migraine headache
- Usually unilateral
- Throbbing/pulsatile
- Increases with severity –> nausea and vomiting follow
- Osmophobia - fear of odours
- Cutaneous allodynia - pain to normal stimuli
What is cutaneous allodynia
Pain to normal stimuli
Describe migraine postdrome
- Sudden head movement transiently causes pain in the location of the antecedent headache
- Feel drained and exhausted
Migraine precipitating factors
- Emotional stress
- Female hormones
- Not eating
- Weather
- Sleep disturbance
- Odour
- Neck pain
- Lights
- Alcohol
3 large classification groups for migraine
- Migraine without aura
- Migraine with aura
- Chronic migraine
Subgroups of migraine with aura
- Typical aura
- Brainstem aura - no motor weakness
- Hemiplegic - motor weakness - familial (T1,2,3) or sporadic
- Retinal - monoocular disturbances
Name of the clinical diagnosis for migraine
ICHD-3 (international classification of headache disorders)
Migraine diagnosis history
- Headaches 4-72 hours
- Associated symptoms
Tests for migraine
Usually tests of exclusion - no definitive test
- MRI with contrast
- Vascular imaging
- Bloods
- Lumbar puncture
Tests of exclusion - migraines - more serious things - SNOOP4
- Systemic
- Neuro
- Onset
- Older
- Pattern change
- Papilloedema
- Precipitating factors
- Positional aggravation
What happens to ESR in migrains
Normal
abnormal in temporal arteritis
Testing for migraines and LP is abnormal
- SAH
- Meningitis
DDX for migraines
- Tension or cluster headache
- Medication overuse
- Post-traumatic
- SAH
- Cerebral neoplasm
- Low pressure headache
- CNS infection
ICHD-3 criteria for migraine without aura and with aura
- > 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
Migraine management and treatment
- Symptom relief - NSAID, aspirin, anti-emetic, hydration, paracetamol
Migraine prevention
- CBT
- Anticonvulasants - Valproate, Topiramate
- TCAs
- Beta-blockers
