Migraines Flashcards
What is a migraine characterised by?
Tendency to get repeated attacks, triggered by certain things, easily hung over, visual vertigo, motion sickness.
What are 3 types of migraines?
Only pain, pain with focal symptoms, focal symptoms only. Focal symptoms includes things like speech arrest and aphasia, weakness, pins and needles.
What are the 5 phases of a migraine?
- Prodrome: Changes in mood, urination, fluid retention, food craving, yawning
- Aura: Visual, sensory (numbness/paraesthesia), weakness, speech arrest
- Headache: Head and body pain, nausea, photophobia
- Resolution: rest and sleep
- Recovery: mood disturbed, food intolerance, feeling hungover
What is aura
Consists of positive and negative phenomena such as scintillations and blindspots.
What are 4 ways of treating an acute migraine attack?
- Aspirin/ibuprofen (Non-steroidals) and paracetamol and metoclopramide (anti-emetic) - Metoclopramide is a pro-kinetic agent, stimulates peristalsis, helping with the nausea as people with migraines suffer from gastric paresis. Use soluble preparations to aid absorption.
- Triptans - synergise NSAIDs. Tablets, melts, nasal sprays, s/c injections (vasoconstrictors)
- A short nap
- Transcranial Magnetic Stimulation -interrupts complex networks that trigger and perpetuate migraine, which is caused by spreading electrical depression across the cerebral cortex.
What are 2 important points to bear in mind when treating a migraine?
- Hit headache hard and fast - difficult to reduce symptoms once it has set in properly.
- Careful with opiate usage as potential for analgesic abuse
What are lifestyle issues and triggers migraneurs have?
Overstimulated brain constantly. Triggers can be dietary, environmental, hormonal, weather, dehydration, stress.
- Drink 2L water
- Avoid caffeine
- Avoid late nights + electronic devices
- Eat regularly
- Potential for analgesic abuse
What is prophylactic treatment for migraines?
- Over-the-counter preparations: feverfew, coenzyme Q10, riboflavin, magnesium, EPO, nicotinamide
- Tricyclic antidepressants (TCAs): amitriptyline 7pm
- Beta-blockers - Propranolol, Atenolol
- Serotonin antagonists: pizotifen, methysergide
- Calcium channel blockers: flunarazine, verapamil
- Anticonvulsants: valproate, topiramate, gabapentin
- Greater occipital nerve blocks
- Botox: crown of thorns
- Suppress ovulation (progesterone only pill or implant/injection)
COBB STAGS
What is erenumab and what is it used for?
Is an injectable drug erenumab (Aimovig). Cuts number of days people had migraines from an average of 8 a month to between 4 and 5 a month.
Monoclonal antibody - disables calcitonin gene-related peptide or its receptor (CGRP mAbs)
Episodic migraine, chronic migraine, or cluster headache.
What is a tension type headache and how is it treated?
Tight muscles around head and neck bilaterally, as though head is in a vice.
Treatments:
NSAID’s preferred: Ibuprofen Naproxen, Diclofenac
Paracetamol
Tricyclic antidepressants:-Amitriptyline 50-75mg daily
30-60% derive some symptomatic relief
SSRI’s probably less effective
Biofeedback and relaxation unproven
What is a cluster headache?
Severe unilateral pain lasting 15-180 minutes untreated. At least one of the following, ipsilaterally:
Conjunctival redness and/or lacrimation
Nasal congestion and/or rhinorrhoea
Eyelid oedema
Classified as a trigeminal autonomic cephalgia.
What are symptoms of a cluster headache?
Forehead and facial sweating
Miosis and/or ptosis
A sense of restlessness or agitation
Frequency between one on alternate days to 8 per day.
Not associated with a brain lesion on MRI
What is acute treatment for a cluster headache?
- Inhaled oxygen. Oxygen inhibits neuronal activation in the trigeminocervical complex
- S/C or Nasal Sumatriptan
What are preventative treatments for a cluster headache?
Verapamil Prednisolone Lithium Valproate Gabapentin Topiramate Pizotifen
