migraines

Question 1

what is an aura?

Answer 1

sensory disturbance before the migraine

Question 2

outline the pathophysiology of migraines?

Answer 2

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

Question 3

which blood vessels are implicated in migraines?

what is happening to the diameter of these vessels?

Answer 3

meningeal vessels

dilate

Question 4

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

Answer 4

brainstem

Question 5

classic migraines are with or without an aura?

Answer 5

with aura

Question 6

how many migraines are classic migraines?

Answer 6

1/3

Question 7

Which gender is a risk factor for migraines?

Answer 7

females

Question 8

is smoking or obesity a risk factor for migraines?

Answer 8

obesity

Question 9

which two foods can be triggers for migraines?

why?

Answer 9

cheese + chocolate

contain tyramine

Question 10

which drink can trigger migraines (asides from alcohol)?

why?

Answer 10

coffee

caffeine

Question 11

which contraceptive can trigger migraines?

Answer 11

oral pill

Question 12

acronym for remembering risk factors?

what does the acronym stand for?

Answer 12

CHOCOLATE

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

Question 13

can depression trigger migraines?

Answer 13

yes

Question 14

can dim lights trigger migraines?

Answer 14

no

but bright lights do

Question 15

what category of diagnosis is migraines?

Answer 15

clinical

Question 16

why would yo do an MRI?

Answer 16

rule out subarachnoid haemorrhage

Question 17

why would you do an ESR?

what are you trying to rule out

Answer 17

giant cell arteritis

Question 18

how long do symptoms last?

Answer 18

4-72 hours

Question 19

which two sensory stimuli cause discomfort?

medical words for these?

Answer 19

light + sound

photophobia
phonophobia

Question 20

aura symptoms are split into what two categories?

Answer 20

typical

atypical

Question 21

typical aura symptoms?

-5

Answer 21

Visual symptoms (e.g. zig zag lines)

Paraesthesia

Speech disturbance

Transient hemianopia

Spreading scintillating scotoma

Question 22

which lasts longer, typical or atypical?

Answer 22

atypical

Question 23

how long does typical aura usually last?

- give range

Answer 23

5-60 minutes

Question 24

which type of visual loss might occur?

Answer 24

hemianopia

Question 25

what can happen to GCS score?

Answer 25

decrease

Question 26

2nd line prophylaxis? how long for, give range?

Answer 26

acupuncture 5-8 weeks

Question 27

1st line prohyplais? | - 3 drug names

Answer 27

propranolol topiramate amitriptyline

Question 28

which beta blocker can be given prophylactically?

Answer 28

propranolol

Question 29

which anti-depressant can be given prophylactically?

Answer 29

amitriptyline

Question 30

topiramate is what class of drug? what two conditions does it most commonly treat?

Answer 30

anticonvulsants epilepsy + migraines

Question 31

pt with menstrual migraines. prophylaxis? - two

Answer 31

Frovatriptan or Zolmitriptan

Question 32

topiramate has what effect on vessel diameter?

Answer 32

dilates

Question 33

migraine over 72 hours. what is it called now? % of migraines that can become this?

Answer 33

Status migrainosus <1%

Question 34

triptans has what effect on vessel diameter?

Answer 34

constricts

Question 35

outline the pathophysiology of migraines?

Answer 35

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

Question 36

someone is having acute migraine. what triple therapy do you give?

Answer 36

Oral sumatriptan + NSAID + paracetamol

Question 37

which NSAID do yo give acutely for a migraine? | -2

Answer 37

ibuprofen & aspirin

Question 38

pt with migraines complains of N&V. what drug group is given?

Answer 38

anti-emetic

Question 39

pt with migraines complains of N&V. what drugs are commonly given? -2 named e.g.

Answer 39

metoclopramide or prochlorperazine

Question 40

pt has migraine, where do they want to go?

Answer 40

dark quiet room

Question 41

character of headache in migraine?

Answer 41

pulsating

Question 42

unilateral or bilateral?

Answer 42

unilateral

Question 43

difference in length of headaches between | migraines and clusters?

Answer 43

Migraines - 4 - 72 hours | Cluster - <3 hours

Question 44

genders effected most in migraines and clusters?

Answer 44

migraines - F | clusters - M

Question 45

where is pain centred in cluster headache?

Answer 45

around one eye

Question 46

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

Answer 46

migraines - dark quiet room | cluster - pace and bang head against wall

Question 47

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

Answer 47

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

Question 48

someone is having acute migraine. what triple therapy do you give?

Answer 48

Oral sumatriptan + NSAID + paracetamol

Question 49

propranolol effect on vessel diameter?

Answer 49

vasodilators

Question 50

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

Answer 50

60%