Migraines

Question 1

definition of migraine

Answer 1

recurrent headache for 4-72 hours w visual +/ GI disturbances

Question 2

clinical presentation w/o aura

Answer 2

photosensitivity
nausea
premonitory symptoms

Question 3

aura

Answer 3

same as without but also experience visual disturbances

ziggy zaggy lines

Question 4

variant clinical presentation

Answer 4

unilateral motor/sensory

resembles stroke

Question 5

pathophysiology of migraines

Answer 5

changes in brainstem blood flow 
=unstable trigeminal nerve nucleus
and basal thalamus nucleus
= release vasoactive neuropeptides 
=neurogenic inflammation 
vasodilation 
plasma protein extravasation

Question 6

pathophysiology of auras in migraines

Answer 6

cortical spreading depression is a self propagating wave of neuronal and glial depolarization that spreads across cortex

Question 7

epidemiology

Answer 7

large genetic component fhx
female
before 40 arises

Question 8

causes CHOCOLATE

Answer 8

no specific cause but triggers:
C- chocolate
H- hangovers
O - orgasms
C- cheese
O- oral contraceptives 
L- lie ins
A- alcohol
T - Tumult- loud noises
E- exercise

Question 9

diagnosis criteria for w/o

Answer 9

4 of criteria

• 5 attacks
• last 4-72 hours
• during have vomiting/nausea or photosensitivity
• two of: unilateral, moderate/severe, pulsing, aggravated by exercise

Question 10

criteria for w aura

Answer 10

2 attacks
last 4-72 hours
2 of unilateral/pulsing/moderate/severe/aggravated by exercise
aura symptoms that last 5-60 mins are unilateral
may accompany w headache
aura spreads over 5 mins

Question 11

investigations

Answer 11

neuro to rule out mass lesions or haemorrhage

Question 12

management

Answer 12

no cure
manage symptoms with painkillers
acute- paracetamol/NSAIDS
severe- sumatriptan