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Neurology > migraines > Flashcards

migraines Flashcards

1
Q

what is an aura?

A

sensory disturbance before the migraine

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2
Q

outline the pathophysiology of migraines?

A

Neuron hyperexcitability in brainstem –> this releases inflammatory substances –> dilates meningeal blood vessels ∴ sensitises surrounding nerve fibres to previously ignored stimuli –> feel pain more, i.e. headache

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3
Q

which blood vessels are implicated in migraines?

what is happening to the diameter of these vessels?

A

meningeal vessels

dilate

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4
Q

from where in the brain does the pathophysiology of migraines begin?

A

brainstem

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5
Q

classic migraines are with or without an aura?

A

with aura

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6
Q

how many migraines are classic migraines?

A

1/3

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7
Q

Which gender is a risk factor for migraines?

A

females

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8
Q

is smoking or obesity a risk factor for migraines?

A

obesity

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9
Q

which two foods can be triggers for migraines?

why?

A

cheese + chocolate

contain tyramine

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10
Q

which drink can trigger migraines (asides from alcohol)?

why?

A

coffee

caffeine

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11
Q

which contraceptive can trigger migraines?

A

oral pill

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12
Q

acronym for remembering risk factors?

what does the acronym stand for?

A

CHOCOLATE

  • chocolate
  • oral contraceptive
  • caffeine
  • alcohol
  • anxiety
  • altitude changes
  • exercise
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13
Q

can depression trigger migraines?

A

yes

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14
Q

can dim lights trigger migraines?

A

no

but bright lights do

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15
Q

what category of diagnosis is migraines?

A

clinical

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16
Q

why would yo do an MRI?

A

rule out subarachnoid haemorrhage

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17
Q

why would you do an ESR?

what are you trying to rule out

A

giant cell arteritis

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18
Q

how long do symptoms last?

A

4-72 hours

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19
Q

which two sensory stimuli cause discomfort?

medical words for these?

A

light + sound

photophobia
phonophobia

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20
Q

aura symptoms are split into what two categories?

A

typical

atypical

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21
Q

typical aura symptoms?

-5

A

Visual symptoms (e.g. zig zag lines)

Paraesthesia

Speech disturbance

Transient hemianopia

Spreading scintillating scotoma

22
Q

which lasts longer, typical or atypical?

A

atypical

23
Q

how long does typical aura usually last?

- give range

A

5-60 minutes

24
Q

which type of visual loss might occur?

A

hemianopia

25
Q

what can happen to GCS score?

A

decrease

26
Q

2nd line prophylaxis?

how long for, give range?

A

acupuncture

5-8 weeks

27
Q

1st line prohyplais?

- 3 drug names

A

propranolol
topiramate
amitriptyline

28
Q

which beta blocker can be given prophylactically?

A

propranolol

29
Q

which anti-depressant can be given prophylactically?

A

amitriptyline

30
Q

topiramate is what class of drug?

what two conditions does it most commonly treat?

A

anticonvulsants

epilepsy + migraines

31
Q

pt with menstrual migraines.

prophylaxis?
- two

A

Frovatriptan or Zolmitriptan

32
Q

topiramate has what effect on vessel diameter?

A

dilates

33
Q

migraine over 72 hours.

what is it called now?

% of migraines that can become this?

A

Status migrainosus

<1%

34
Q

triptans has what effect on vessel diameter?

A

constricts

35
Q

outline the pathophysiology of migraines?

A

Neuron hyperexcitability in brainstem –> this releases inflammatory substances –> dilates meningeal blood vessels ∴ sensitises surrounding nerve fibres to previously ignored stimuli –> feel pain more, i.e. headache

36
Q

someone is having acute migraine.

what triple therapy do you give?

A

Oral sumatriptan + NSAID + paracetamol

37
Q

which NSAID do yo give acutely for a migraine?

-2

A

ibuprofen & aspirin

38
Q

pt with migraines complains of N&V.

what drug group is given?

A

anti-emetic

39
Q

pt with migraines complains of N&V.

what drugs are commonly given?
-2 named e.g.

A

metoclopramide or prochlorperazine

40
Q

pt has migraine, where do they want to go?

A

dark quiet room

41
Q

character of headache in migraine?

A

pulsating

42
Q

unilateral or bilateral?

A

unilateral

43
Q

difference in length of headaches between

migraines and clusters?

A

Migraines - 4 - 72 hours

Cluster - <3 hours

44
Q

genders effected most in migraines and clusters?

A

migraines - F

clusters - M

45
Q

where is pain centred in cluster headache?

A

around one eye

46
Q

what do pt want to do when they have a
migraines?
vs
cluster?

A

migraines - dark quiet room

cluster - pace and bang head against wall

47
Q

which meds can you use in migraines acutely but you do not use in cluster headcahes?

A

cluster - do not use oral triptans, NSAIDs, or paracetamol.

48
Q

someone is having acute migraine.

what triple therapy do you give?

A

Oral sumatriptan + NSAID + paracetamol

49
Q

propranolol effect on vessel diameter?

A

vasodilators

50
Q

% wise how many migraine pts get better with treatment or grow out of it with age?

A

60%

Neurology (40 decks)

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