Migraines Flashcards
What are the 4 main types of migraine?
Migraine without aura
Migraine with aura
Silent migraine (aura but no headache)
Hemiplegic migraine
What features of a migraine headache can differentiate it from other types of headaches?
Lasts 4-72 hrs Moderate-severe intensity Pounding/throbbing Better when lying down-> differentiates from ICP associated headache Normally unilateral Photophobia Phonophobia \+/- aura N+V
What is aura in the context of a migraine?
Visual changes
- sparks in vision
- blurring
- lines across vision
- loss of visual fields
How would someone suffering from hemiplegic migraine present? What is important to rule out in these patients?
Migraine symptoms Sudden or gradual onset Hemiplegia Ataxia Changes in consciousness
What are the potential migraine triggers?
Stress Bright lights Strong smells Chocolate, cheese or caffeine Dehydration Menstruation Abnormal sleep patterns Trauma
What are the typical 5 stages of migraine?
Premonitory/prodromal=
-subtle symptoms over several days prior to migraine i.e. yawning, fatigue, changes in mood
Aura= up to 60 mins
- can be induced by flickering lights due to inducing the occipital lobe to fire signals at the same freq
- Fortication spectral= jagged lights across visual field
- Scotoma= blind spot in vision i.e. spreading black cloud due to nerve cells switching off after increased activity with light flickering
Headache= 4-72 hrs
Resolution= headache resolves
Postdromal/recovery
How can a migraine episode be managed acutely?
Sleep in dark room Paracetamol Triptans NSAIDs Antiemetics (metoclopramide)
What is the role of triptans in migraine management? What is their MOA?
5HT receptor agonists used to abort migraine as it develops
MOA:
- vasoconstriction of SM in arteries
- inhibit activation of peripheral pain receptors
- reduce neuronal activity in CNS
What can be done as part of migraine prophylaxis?
Keep headache diary so can identify possible triggers
Long term meds to reduce freq and severity:
-betablocker= propranolol
-topiramate (teratogenic)
-candesartan
-valproate
-amitriptyline (TCA)
Acupuncture
Botox into scalp
Riboflavin (B12 supplementation)
NSAIDs prophylaxis when migraines associated with menstruation
What are common non-headache manifestations of chronic migraine?
Chronic fatigue Mood and cognitive disturbance i.e. insomnia/irritability Stuttering Stimulus sensitivity Migraine related dysequilibrium Migraine vertigo Reflex syncope Restless legs Sensory disturbance Back pain Diffuse muscle tenderness
What new treatment has been developed that might help with treatment of refractory migranes?
What forms is the treatment currently available?
CGRP blockade:
- CGRP is released from c-fibres and increases the sensitivity of A-alpha fibres which increases the risk of migraines
- by blocking CGRP release you are blocking sensitisation of A-alpha fibres
Options: -antagonists= acute I.e. Antogepant/Rimegenant -MAb= prophylaxis -Fremaezumab= used for those with chronic migraines which have failed 1 treatment
