migraines Flashcards
what is an aura?
sensory disturbance before the migraine
outline the pathophysiology of migraines?
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
which blood vessels are implicated in migraines?
what is happening to the diameter of these vessels?
meningeal vessels
dilate
from where in the brain does the pathophysiology of migraines begin?
brainstem
classic migraines are with or without an aura?
with aura
how many migraines are classic migraines?
1/3
Which gender is a risk factor for migraines?
females
is smoking or obesity a risk factor for migraines?
obesity
which two foods can be triggers for migraines?
why?
cheese + chocolate
contain tyramine
which drink can trigger migraines (asides from alcohol)?
why?
coffee
caffeine
which contraceptive can trigger migraines?
oral pill
acronym for remembering risk factors?
what does the acronym stand for?
CHOCOLATE
- chocolate
- oral contraceptive
- caffeine
- alcohol
- anxiety
- altitude changes
- exercise
can depression trigger migraines?
yes
can dim lights trigger migraines?
no
but bright lights do
what category of diagnosis is migraines?
clinical
why would yo do an MRI?
rule out subarachnoid haemorrhage
why would you do an ESR?
what are you trying to rule out
giant cell arteritis
how long do symptoms last?
4-72 hours
which two sensory stimuli cause discomfort?
medical words for these?
light + sound
photophobia
phonophobia
aura symptoms are split into what two categories?
typical
atypical
typical aura symptoms?
-5
Visual symptoms (e.g. zig zag lines)
Paraesthesia
Speech disturbance
Transient hemianopia
Spreading scintillating scotoma
which lasts longer, typical or atypical?
atypical
how long does typical aura usually last?
- give range
5-60 minutes
which type of visual loss might occur?
hemianopia
what can happen to GCS score?
decrease
2nd line prophylaxis?
how long for, give range?
acupuncture
5-8 weeks
1st line prohyplais?
- 3 drug names
propranolol
topiramate
amitriptyline
which beta blocker can be given prophylactically?
propranolol
which anti-depressant can be given prophylactically?
amitriptyline
topiramate is what class of drug?
what two conditions does it most commonly treat?
anticonvulsants
epilepsy + migraines
pt with menstrual migraines.
prophylaxis?
- two
Frovatriptan or Zolmitriptan
topiramate has what effect on vessel diameter?
dilates
migraine over 72 hours.
what is it called now?
% of migraines that can become this?
Status migrainosus
<1%
triptans has what effect on vessel diameter?
constricts
outline the pathophysiology of migraines?
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
someone is having acute migraine.
what triple therapy do you give?
Oral sumatriptan + NSAID + paracetamol
which NSAID do yo give acutely for a migraine?
-2
ibuprofen & aspirin
pt with migraines complains of N&V.
what drug group is given?
anti-emetic
pt with migraines complains of N&V.
what drugs are commonly given?
-2 named e.g.
metoclopramide or prochlorperazine
pt has migraine, where do they want to go?
dark quiet room
character of headache in migraine?
pulsating
unilateral or bilateral?
unilateral
difference in length of headaches between
migraines and clusters?
Migraines - 4 - 72 hours
Cluster - <3 hours
genders effected most in migraines and clusters?
migraines - F
clusters - M
where is pain centred in cluster headache?
around one eye
what do pt want to do when they have a
migraines?
vs
cluster?
migraines - dark quiet room
cluster - pace and bang head against wall
which meds can you use in migraines acutely but you do not use in cluster headcahes?
cluster - do not use oral triptans, NSAIDs, or paracetamol.
someone is having acute migraine.
what triple therapy do you give?
Oral sumatriptan + NSAID + paracetamol
propranolol effect on vessel diameter?
vasodilators
% wise how many migraine pts get better with treatment or grow out of it with age?
60%
