Migraines Flashcards
What are migraines?
a recurrent throbbing headache that typically affects one side of the head and is often accompanied by nausea and disturbed vision. They do not threaten health, they are self limiting and can reduce with age.
What are migraines linked to?
depression
suicide
increased risk of stroke
increased risk of glaucoma
What are the symptoms of migraines?
severe throbbing or pulsing HA
often temporal or retrobulbar (behind eye)
nausea or vomiting
photophobia and phonophobia
last hours or days
can have prodromal symptoms before HA comes on, like aura
What are the classifications of migraines?
migraine with aura
migraine without aura
What are the different phases of migraines?
prodromal phase
aura phase (zigzagging) 5-30 min
headache phase - hours or days
postdromal phase (feel fatigue and tired) 1-2 days
What is the three theories of migraine pathophysiology?
depolarisation theory
vascular theory
serotonin theory
What is the depolarisation theory?
neurological activity is depressed over an area of the cortex of the brain. results in the release of inflammatory mediators leading to irrigation of cranial nerve roots
What is the vascular theory?
when blood vessels in the brain contract and expand inappropriately. May start in the occipital lobe in the back of the brain as arteries spasm. The reduced blood flow to the occipital lobe triggers the aura because the visual cortex is in the occipital area.
What is the serotonin theory?
Serotonin is a transmitter that helps to control mood, pain, sensation, sexual behaviour, sleep and dilation and constriction of the blood vessels.
Low serotonin levels in the brain may cause constriction and dilation of the blood vessels which trigger a migraine.
What are the types of non-visual aura that is experienced?
scalp tenderness
pins and needles, tingling sensation
numbness of the limbs
limb weakness
dysphasia
What are the precipitating factors of a migraine?
caffeine
chocolate
alcohol
MSG
anxiety
psycho-social stress
strenuous activity
menstruation
oral contraceptives
fever or illness
What are the relieving factors of a migraine?
caffeine
codeine, ibuprofen
migraine trigger avoidance
acupuncture
relaxation massage
physiotherapy
magnesium, vit B supps, some hrbal meds
DDx for migraine without aura?
tension
dehydration
visual function induced
cluster headache
drug related or rebound headache
infection
intracranial disorder
DDx for migraine with aura?
cerebral ischaemia/TIA
cerebral embolus
arterio-venous malformations (AVM)
oestrogen-induced cerebrovascular
compressive lesion of the visual pathway including brain tumours, aneurysms, haemorrhages
other possible precipitating factors in migraines?
anisometropia
astigmatism
transient benign anisocoria
transient visual field deficits
flicker VF methods ore sensitive for these losses
