Migraines

Question 1

Aura

Answer 1

Visual disturbances (flashing lights, moving lines) probably driven by cortical spreading depression

Question 2

Migraine causes

Answer 2

More in women than men, possibly connected to sex hormones
Familial hemiplegic migraines are autosomal dominant inherited
Mutations that lower the threshold for cortical spreading depression are connected

Question 3

Trigeminal system

Answer 3

Trigeminal nerve: largest cranial nerve
Involves ophthalmic, maxillary, and mandibular branches
Innervates dura mater
Controls cerebral blood vessels

Question 4

Migraine mechanism

Answer 4

Neurovascular disease, dilation of cranial blood vessels
Low 5HT levels
Elevated CGRP

Question 5

Pharmacologic treatments

Answer 5

Beta blockers, anticonvulsants, SSRIs, non specific analgesics

Question 6

Medication overuse headache

Answer 6

Increased risk and intensity of future migraines following analgesic use for headache

Question 7

Caffeine and migraine

Answer 7

Adenosine receptor antagonist
Cause vasoconstriction
Increases absorption of some analgesics
Improves migraine symptoms but may trigger headaches or cause rebound headaches

Question 8

Ergotamines

Answer 8

5HT-1b/d agonists
Low selectivity, risk of side effects
Can produce coronary vasoconstriction, contraindicated for people with heart or high blood pressure problems
High first pass metabolism, low bioavailability

Question 9

Triptans

Answer 9

Selective 5HT1b/d agonists
Vasoconstrictors, inhibit trigeminal nerve
Moderate bioavailability, high when given subcutaneous
Metabolized by monoamine oxidase (like 5HT)

Question 10

Migraine treatments in development

Answer 10

CGRP receptor or molecule antibodies
Small molecule CGRP antagonists