Migraine and Emesis Flashcards
When do migranes peak? Whichsex is more common?
Middle age
Females
Whats a predromal sign?
60% of migraines have these
Hyperactivity
Yawning
Mood or appetite change
Describe aura
Initial visual disturbance
30 mins
Visual area lost, surrounding area shimmers
Classical membrane
Describe unilateral throbbing headache
Photophobia
Nausea and vom
Prostate
Worse with light
Resolution- deep sleep and loss of headache
Recovery- exhaustion
what is thought to be the cause of migranes? how is this shown in an MRI?
neurovascular, trigemal nerve activated causing vasodilation near neuronal blood flow. (via release of CGRP) trigeminal nn projects to Trigeminal nucleus then to cortex = pain
MRI shows decreased blood flow by 27% during aura then prolonged increase
List some trigger factors
Chocolate Mental stress Fruit Eggs Alcohol Oral contraceptives Time zone shifts Physical exertion Refractory errors in glasses
Goals of medication
Primary to provide acute relief to recurrent attacks
Secondary to introduce effective prophylactic treatment
NSAIDs Triptans B blockers, Ca channel blockers, anti convulsants, pre menstrual oestrogen Amitryptyline Gabapentin, acupuncture
Define emesis
Vomiting
Protective reflex to expel ingested toxins, shown on man and most meal feeding mammals, assoc with nausea
Define nausea
Unpleasant sensation that immediately precedes vomiting
describe the process of vomiting(emesis)
higher centres stim resp stop increased intra abdo pressure, intragastric pressure (diaphragm and abdo muscles contract) antiperistalsis LES relaxes glottis closes over trachea
Vomiting centre inputs
Chemoreceptor trigger zone
Area postrema
Vestibular system- motion sickness
usually NK1 antagonists, substance P is major output transmitter from vom centre
Drugs
H1 and H3 antagonists- motion sickness
Chemo- 5HT antagonists
Benzodiazepines for nausea
