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PM3B > Migraine > Flashcards

Migraine Flashcards

1
Q

What are primary headaches?

A

Migraine
cluster headache
tension
Not caused by anything else

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2
Q

What is the prevalence of migraine?

A

1 in 7 people

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3
Q

What does a migraine feel like?

A

Nausea
cannot talk /stand/read
high pitch sound

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4
Q

What age does migraine affect people?

A

18-55 people in most productive years.

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5
Q

Where is. severe migraine ranked?

A

Highest disability group

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6
Q

What is classification of migraines

A

Episodic migraine - occurs on <15 days in month

Chronic migraine - occurs on >15 days

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7
Q

What are the 2 major subtypes of mgiraine?

A

With aura

without aura

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8
Q

What major subtype. of migraine is most common?

A

Without aura

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9
Q

Which major subtype of migraine is more debilitating?

A

MOre debilitating

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10
Q

What are the characteristics of a migraine and what do you need to classify as a migraine?

A

At leas 5 attacks lasting between 4-72 hours

At leat 2 of - unilateral, pulsating, moderate/severe. pain, can’t do normal routine activity

and during the attack need 1 of - nausea and vomiting, photophobia/phonophobia

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11
Q

What is the characteristic diagnostic criteria of migraine with aura?

A

at least 2 attacks between 4 & 72 hrs
no motor weakness
Aura with reversibly visual symptoms - flickering lights, spots, loss vision

Fully reversible sensory symptoms e.g. pins and needles, numbness

And at least 2 of visual symptoms or unilateral sensory symptoms

Doesn’t last long e.g. develops gradually over 5 mins and lasts between 5 and 60mins. Then the headache without aura begins after

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12
Q

What are some complications of migraine?

A

Migraine epilepticus >72hrs (A&E)
Migranous infarction (stroke)
Persistent aura without infarction >1 week
Migraine aura-triggered seizures

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13
Q

what are migraine triggers?

A

Inherited - genetic predisposition makes people more sensitive to triggers than normal people
Lifestyle e.g. chocolate, caffeine, alcohol, sleeping late/insomnia, strip lighting, stress

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14
Q

What is the current theory of migraine pathophysiology?

A

Neurovascular disease - activation and sensitisation of trigeminovascular pain pathway - innervation of cranial tissue and cortical spreading depression - leads to neurogenic inflammation (also get vasodilation) and CGRP activation

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15
Q

what is the 1st line acute treatments for migraine?

A
  • Aspirin 900mg
  • Ibuprofen 400mg (if ineffective increase to 600mg)
  • Triptans. e.g/ sumatriptan 50-85mg and naproxen 500mg
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16
Q

What are current prescribed medications for migraines?

A 
Beta blockers
Triptans 
TCAs anti depressants 
Codeine 
Botox
17
Q

What are migraine treatments often co-prescribed with?

A

Anti-emetics e.g. metoclopramide 10mg or prochlorperazine 10mg
Metoclopramide not used as much due to d2 antagonism and Extrapyrimidal side effects

18
Q

What are the 3 proposed mechanisms for the actions of triptans?

A
  1. constriction of cranial arteries/BV
  2. inhibitory actions on CNS
  3. inhibition of presynaptic trigeminal ganglion neurones which reduces release of CGRP NT
19
Q

What happens if you continually use sumatriptan?

A

Rebound headaches

20
Q

What is the OTC supply criteria for sumatriptan?

A

Must be diagnosed by a dr or pharmacist
Have an established pattern of 5 or more a year
Simple analgesics have been tried & ineffective

21
Q

What is the dosage for sumatriptan?

A

one 50mg dose, then if doesn’t work can take another dose. But if it does not improve after 30 minutss, no further doses due to risk of rebound headaches

22
Q

Are monoclonal antibodies used to treat migraine?

A

they have been rejected by NICE as not cost effective. Was called erunumab

23
Q

What is the role of CGRP in migraine?

A

It is a neuropeptide increased in migraine - it is a potent vasodilator and involved in neurogenic inflammation and nociception.

24
Q

What is sumatriptan contra-indicated in?

A

Cardiovascular disease
Hypertension
Pregnancy

25
Q

What are triptans?

A

Agonists of the serotonin receptor - 5-hydroxytriptamine. 5-HT is involved as it is reduced in attacks so we want to increase 5-ht levels.

PM3B (13 decks)

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