Migraine Flashcards
Define a migraine?
Severe episodic headache that may have a prodrome of focal neurological symptoms (aura) and is associated with systemic disturbance (can cause other symptoms making it different from a headache) Aura is basics the symptoms before a migraine begins e.g. vision changes, dizziness, confusion, feeling prickling skin, and weakness.
what are the three classifications of migraines?
migraine with aura ( classical migraine)
migraine without aura ( common migraine)
migraine variants ( eg familial hemiplegic, ophthalmoplegic)
describe the aetiology of migraine?
Poorly understood
Early aura of cortical spreading depression is associated with intracranial vasoconstriction leading to localised ischaemia
This is then followed by meningeal and extracranial vasodilation mediated by serotonin, bradykinin and the trigeminovascular system
summarise the epidemiology of migraine?
Prevalence:
Males - 6%
Females - 15-20%
Usually occurs in adolescence and early adulthood
Therefore if in an older patient = red flag
what are the risk factors for a migraine?
family history of migraine
high caffeine intake
exposure to change in barometric pressure
female sex
stress, exercise, lack of sleep, oral contraceptive
foods - caffeine, alcohol, cheese, chocolate
what is the classical presentation of a migraine?
visual or other aura lasting 15-30min followed within 1 hour by unilateral, throbbing headache
Headache
- Pulsatile
- Duration 4-72 hrs
- Episodic
- chronic daily headaches lasting weeks-> different aetiology
what are the associated symptpms of a migraine?
- Nausea
- Vomiting – usually projectile (can’t control it!)
- Photophobia/Phonophobia
- Want to curl up in the corner of a dark room
Aura:
- Fully reversible visual, sensory and dysphagic speech symptoms
- Flashing lights
- Spots
- Blurring
- Zigzag lines
- Blind spots (scotomas)
- Tingling/numbness in the limbs
- Can have a hemiplegic migraine- but still should investigate stroke etc but just note that you can get weakness due to a migraine
what is the criteria for a migraine with no aura?
>5 headaches lasting 4-72 hours + nausea/vomiting (or photo/phonophobia) + any 2 of: unilateral, pulsating, impairs routine activity
What are the investigations for a migraine?
diagnosis from HISTORY
investigations to exclude other diagnoses
- ESR- raised in temporal artertitis
- CSF culture- look for infection
- MRI- may demonstrate pachymeingeal enhancement in low pressure headache, SOL, ischaemic lesions
- CT head- SOL, ischaemic lesions, SAH
summarise the prognosis of patients with migraines?
Usually CHRONIC
Most cases can be managed well with preventative/early treatment measures
what are the possible complications of migraines?
Disruption of daily activities
Can lead to analgesia-overuse headaches in people who use analgesia regularly
what is something to note in treatment for migraines?
analegesia overuse can cause headahces
what is the acute treatment for migraines?
triptan (5HT1 agonist) + NSAIDs + metoclopramide (IV antiemetic) + hydration
Contraindicated in IHD, coronary vasospasm, HTN, PVD, hx of stroke or TIAs as the way triptans work is by narrowing the blood vessel
outline prophylactic management of migraines?
Remove triggers
Menstrual migraines can be controlled with the oral contraceptive pill, magnesium and triptans
With auras: anticonvulsants (topiramate), TCAs (amitriptyline) + B Blockers (people with reg severe attacks)
what advice should be given to patients that suffer with migraines?
- Avoid triggers
- Rest in a quiet dark room during episodes
- One side lying down in a dark room makes it better
