Migraine Flashcards
What are primary headaches?
Migraine
cluster headache
tension
Not caused by anything else
What is the prevalence of migraine?
1 in 7 people
What does a migraine feel like?
Nausea
cannot talk /stand/read
high pitch sound
What age does migraine affect people?
18-55 people in most productive years.
Where is. severe migraine ranked?
Highest disability group
What is classification of migraines
Episodic migraine - occurs on <15 days in month
Chronic migraine - occurs on >15 days
What are the 2 major subtypes of mgiraine?
With aura
without aura
What major subtype. of migraine is most common?
Without aura
Which major subtype of migraine is more debilitating?
MOre debilitating
What are the characteristics of a migraine and what do you need to classify as a migraine?
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
What is the characteristic diagnostic criteria of migraine with aura?
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
What are some complications of migraine?
Migraine epilepticus >72hrs (A&E)
Migranous infarction (stroke)
Persistent aura without infarction >1 week
Migraine aura-triggered seizures
what are migraine triggers?
Inherited - genetic predisposition makes people more sensitive to triggers than normal people
Lifestyle e.g. chocolate, caffeine, alcohol, sleeping late/insomnia, strip lighting, stress
What is the current theory of migraine pathophysiology?
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
what is the 1st line acute treatments for migraine?
- Aspirin 900mg
- Ibuprofen 400mg (if ineffective increase to 600mg)
- Triptans. e.g/ sumatriptan 50-85mg and naproxen 500mg
What are current prescribed medications for migraines?
Beta blockers Triptans TCAs anti depressants Codeine Botox
What are migraine treatments often co-prescribed with?
Anti-emetics e.g. metoclopramide 10mg or prochlorperazine 10mg
Metoclopramide not used as much due to d2 antagonism and Extrapyrimidal side effects
What are the 3 proposed mechanisms for the actions of triptans?
- constriction of cranial arteries/BV
- inhibitory actions on CNS
- inhibition of presynaptic trigeminal ganglion neurones which reduces release of CGRP NT
What happens if you continually use sumatriptan?
Rebound headaches
What is the OTC supply criteria for sumatriptan?
Must be diagnosed by a dr or pharmacist
Have an established pattern of 5 or more a year
Simple analgesics have been tried & ineffective
What is the dosage for sumatriptan?
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
Are monoclonal antibodies used to treat migraine?
they have been rejected by NICE as not cost effective. Was called erunumab
What is the role of CGRP in migraine?
It is a neuropeptide increased in migraine - it is a potent vasodilator and involved in neurogenic inflammation and nociception.
What is sumatriptan contra-indicated in?
Cardiovascular disease
Hypertension
Pregnancy
What are triptans?
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.
