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Year Two - Neurology System > Migraines > Flashcards

Migraines Flashcards

1
Q

What are migraines?

A

They are defined as a chronic disorder in which patients experience episodic attacks of a headache and other associated clinical features

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2
Q

What is the pathophysiology of migraines?

A

There is no simple explanation for why migraines occur, and it may be a combination of structural, functional, chemical, vascular and inflammatory factors

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3
Q

What are the four classifications of migraines?

A

Migraines Without Aura

Migraines With Aura

Silent Migraines

Hemiplegic Migraines

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4
Q

What are migraines without aura?

A

They are defined as migraines which occurs without specific warning signs just before the headache begins

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5
Q

What are migraines with aura?

A

They are defined as migraines which occurs with specific warning signs just before the headache begins

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6
Q

What are silent migraines?

A

They are defined as migraines that result in aura clinical features; however, no headache is experienced

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7
Q

What are hemiplegic migraines?

A

They are a rare type of migraine in which individuals experience a temporary weakness on one side of their body (hemiplegia) as part of their migraine attack

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8
Q

What do hemiplegic migraines mimic? What do we do as a result?

A

Strokes

It is important to act fast and thoroughly investigate these patients

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9
Q

What are the ten migraine triggers?

A

Chocolate

Hormonal Changes

Orgasms

Cheese/Caffeine

combined Oral contraceptives

Lights

Alcohol

Tiredness

Exercise

Stress

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10
Q

Which gender is at a greater risk of migraines?

A

Females

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11
Q

What should we consider when female patients present with migraines?

A

We should look at their medication list and check whether they are being prescribed the combined oral contraceptive pill

This should then be changed to a progesterone only or non-hormonal contraceptive method

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12
Q

What is an absolute contraindication of the COCP?

A

Migraines with aura

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13
Q

Why is the combined oral contraceptive pill contraindicated in migraine with aura?

A

There is an increased risk of ischaemic stroke

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14
Q

What are the five clinical features of migraines?

A

Severe Unilateral Throbbing Headache

Headache Worsening Due To Exercise

Photophobia

Phonophobia

Nausea & Vomiting

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15
Q

What is photophobia?

A

It is defined as a sensitivity to light

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16
Q

What is phonophobia?

A

It is defined as a sensitivity to sound

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17
Q

How long do migraine attacks usually last?

A

4 – 72 hours

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18
Q

What is a prodrome?

A

It refers to subtle changes that warn of an upcoming migraine, usually occurring three days before the headache

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19
Q

What are the six clinical features of a predrome?

A

Constipation

Urinary Frequency

Neck Stiffness

Mood Changes

Food Cravings

Yawning

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20
Q

What is a migraine aura?

A

It refers to transient neurological symptoms which may occur hours before or during an attack

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21
Q

What are the six clinical features of a migraine aura?

A

Blurry Vision

Hemianopia Disturbances

Spreading Scintillating Scotoma

Paraesthesia

Ataxia

Dysarthria

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22
Q

What is hemianopia?

A

It is defined as vision loss affection half the visual field

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23
Q

What is scotoma?

A

It is defined as a spot in the visual field in which vision is absent or deficient

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24
Q

What is ataxia?

A

It is defined as a group of symptoms including slurred speech, stumbling, falling and incoordination

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25
Q

What is dysarthria?

A

It is a motor speech disorder in which the muscles that are used to produced are damaged, paralysed or weakened

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26
Q

How long do the clinical features of a migraine aura tend to last?

A

15 - 60 minutes

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27
Q

What do migraine auras commonly get mistaken for?

A

A transient ischaemic attack (TIA)

This is due to the fact that it similarly causes a sudden loss of function

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28
Q

Which five aura features are deemed as atypical, requiring further investigation/referral?

A

Motor weakness

Double vision

Unilateral visual disutrbances

Poor balance

Decreased level of consciousness

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29
Q

What is a post-drone?

A

It is a phase that can occur after a migraine attack

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30
Q

What are the three clinical features of a pro-drome?

A

Fatigue

Confusion

Elation

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31
Q

What investigations can be conducted to diagnose a migraine?

A

There are no specific investigations that can be conducted

However, a diagnosis can be aided by the conduction of a migraine diary

32
Q

How long should we advise individuals to keep note of a migraine diary for?

A

A few weeks

33
Q

What information should be noted in a migraine diary?

A

Date

Time

Duration of attack

Clinical features experienced

Medications administered

34
Q

How are migraine diaries used to diagnose/investigate migraines?

A

They allow recognition of overuse headaches, which are caused by administration of painkillers on a long-term basis

It also allows identification of potential triggers for an individual’s migraine, which can allow individuals to take prophylactic measures

35
Q

What would indicate that individuals have a medication overuse migraine?

A

If they take painkillers on more than 10 days every month and experience migraine features

36
Q

What feature would provide a definitive diagnosis of migraine medication overuse headaches?

A

The clinicla features resolve, or revert to their original pattern, within 2 months of stopping the medication

37
Q

What is the migraine diagnostic criteria from ‘The International Headache Society’?

A

There should be at least five migraine attacks, which fulfil the following criteria…

  • Headache duration 4 -72 hours
  • Headache needs to meet two of the following criteria (unilateral, pulsating quality, moderate to severe intensity, aggravated by exercise)
  • During headache there is either nausea and vomiting OR photophobia and photophobia
  • The headache is not attributed to another disorder
38
Q

In what way do we conservatively manage a migraine attack?

A

This involves advising patients to go into
a quiet, dark room to sleep

In some cases, individuals feel better once they have vomited

39
Q

In what three ways do we pharmacologically manage migraine attacks?

A

Basic Analgesia

Triptans

Antiemetics

40
Q

What four basic analgesia drugs can be used to manage migraine attacks?

A

Paracetamol

Ibuprofen

Naproxen

Aspirin

41
Q

When should patients take basic analgesia drugs when managing migraine attacks? Why?

A

It is advised that individuals take these at the first signs of a migraine attack

This gives them time to absorb into the bloodstream and ease symptoms

42
Q

What basic analgesia is not advised for patients to take during a migraine attack?

A

Co-codamol

43
Q

What drug classification do triptans belong to?

A

5HT receptor (serotonin receptor) agonists

44
Q

What two triptans can be administered to manage a migraine attack?

A

Sumatriptan

Rizatriptan

45
Q

What are the three mechanisms of actions of triptans?

A

Vasoconstriction of arteries

Inhibition of peripheral pain receptors

Reduced neuronal activity in the CNS

46
Q

Which administration route of triptans is recommended in adults?

A

Oral

47
Q

Which administration route of triptans is recommended in patients aged 12 - 17?

A

Intranasal

48
Q

What is a side effect of triptans?

A

Chest tightness

49
Q

What are the two contraindications of triptan administration?

A

Cardiovascular Disease

SSRIs

50
Q

What three anti-emetics are used to manage migraines attacks?

A

Chlorpromazine

Metoclopramide

Prochlorperazine

51
Q

What is the first line anti-emetic used to manage migraines?

A

Metoclopramide

52
Q

When are anti-emetics used to manage migraine attacks?

A

If the patient’s migraine with aura is accompanied by nausea and vomiting

53
Q

What is a side effect of metoclopramide, in young patients?

A

Acute dystonia reaction

54
Q

What are the three acute pharmacological management options that can be used to manage predictable menstrual migraines?

A

Mefanamic acid

OR

A combination of aspirin, paracetamol and caffeine

OR

Triptans

55
Q

How do we prevent the development of medication overuse migraines when pharmacologically managing them?

A

We limit the prescription of these drugs to ten per month, which is equivalent to two per week

56
Q

In cases where medication overuse migraines develop, what is the most appropriate management?

A

We stop simple analgesia and triptans abruptly

We withdraw opioid analgesia gradually

57
Q

When is prophylactic management of migraines recommended?

A

> 2 attacks/month

58
Q

In what two ways do we conservatively prevent migraines?

A

We can advise patients about acupuncture therapy. This is usually not conducted by the GP practice and patients would have to explore this privately. It is suggested that individuals trial a course of up to 10 sessions over a 5-8 week period.

We can ask patients to complete a migraine diary to allow identification of potential triggers for an individual’s migraine. This can allow individuals to take prophylactic measures to avoid these triggers.

59
Q

When is acupuncture recommended to prophylactically manage migraines?

A

Third line management option

Following hypertensive and anti-convulsant failure

60
Q

In what four ways can we pharmacologically prevent migraines?

A

Hypertensives

Anti-Convulsants

Tricyclic Antidepressants

Botulin A Injections

61
Q

When do we administer hypertensives to prevent migraines?

A

They are the first line prophylactic medications advised

62
Q

What three hypertensives are used to prevent migraines?

A

Propranolol

Metoprolol

Verapamil

63
Q

When do we administer anti-convulsants to prevent migraines?

A

They are the second line prophylactic medications advised

64
Q

What anti-convulsant do we use to prevent migraines?

A

Topiramate

65
Q

What should we remember when we administer topiramate?

A

It is a teratogenic drug and therefore it should not be administered to pregnant patients and those of child bearing age

66
Q

What are the two teratogenic effects of topiramate?

A

Cleft lip

Cleft palate

67
Q

When are tricyclic antidepressants used to prevent migraines?

A

They are the third line prophylactic medications advised

68
Q

What tricyclic antidepressant is used to prevent migraines?

A

Amitriptyline

69
Q

When should we administer botulin A injections to prevent migraines?

A

They should be considered in individuals who suffer from chronic migraines and as a last resort

70
Q

How often should botulin A injections be administered to prevent migraines?

A

Every 12 weeks

71
Q

What are the two prophylactic pharmacological management options that can be used to manage predictable menstrual migraines? What doses?

A

Frovatriptan (2.5 mg twice a day)

OR

Zolmitriptan (2.5 mg twice or three times a day)

72
Q

How should we generally manage pregnant/breastfeeding patients with migraines?

A

Pharmacological migraine treatment should be limited as much as possible in these patients

Instead, these patients should identify and avoid potential migraine triggers

73
Q

When pharmacological management is essential, what is the first line pharmacological management option in pregnant/breastfeeding patients with migraines?

A

Paracetamol 1g

74
Q

When pharmacological management is essential, what is the second line pharmacological management option in pregnant/breastfeeding patients with migraines? In which two trimesters can this be administered in?

A

NSAIDs

First & second

75
Q

Which two opioids should be avoided during pregnancy to manage migraines?

A

Aspirin

Codeine

76
Q

Is HRT safe to administer in a patient with a history of migraine?

A

Yes, however it can make the migraines worse

Year Two - Neurology System (25 decks)

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