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C. Year 3 MLA Neurology/Behaviour Conditions/Diseases > Migraines > Flashcards

Migraines Flashcards

1
Q

What is the most common type of primary headache?

1 - migraines
2 - thunderclap
3 - tension type
4 - cluster

A

3 - tension type
- migraine is the 2nd most common form of primary headache

  • incidence of 0.5-5%
  • difficult to identify exact incidence
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2
Q

What is the most common debilitating headache?

1 - tension headache
2 - thunderclap headache
3 - Migraine
4 - Cluster headaches

A

3 - Migraine
- also 2nd most common type of primary headaches

  • 7th highest cause disability globally
  • 2.9% of years of life lost to disability
  • twice as likely in women
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3
Q

What is a primary headache?

1 - no known underlying cause
2 - trauma related headache
3 - infectious related headache
4 - headaches associated with a specific aetiology causing traction on or inflammation of pain-sensitive structures

A

1 - no known underlying cause

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4
Q

What is a secondary headache?

1 - no known underlying cause
2 - trauma related headache
3 - infectious related headache
4 - headaches associated with a specific aetiology causing traction on or inflammation of pain-sensitive structures

A

4 - headaches associated with a specific aetiology causing traction on or inflammation of pain-sensitive structures

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5
Q

Are primary or secondary headaches more common?

A
  • primary
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6
Q

What is the incidence of migraines?

1 - 50/100,000
2 - 500/100,000
3 - 5000/100,000
4 - 50,000/100,000

A

3 - 5000/100,000

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7
Q

At what time do migraines generally start and begin to decline?

1 - starts at puberty and declines around 20y/o
2 - starts at puberty and declines around 40y/o
3 - starts at puberty and declines around 60y/o
4 - starts at puberty and declines around 80y/o

A

2 - starts at puberty and declines around 40y/o

  • 2% have chronic migraines, causing medication overuse
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8
Q

Are migraines more common in men or women?

A
  • women
  • 3x more likely
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9
Q

Menstrual migraines can occur in women. When would these generally occur?

1 - days 1-2
2 - days 2-3
3 - days 5-7

A

2 - days 2-3

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10
Q

Are patients with comorbid psychiatric disorders such as anxiety & depression more or less likely to experience medication overuse headaches?

A
  • more likely
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11
Q

Which cranial nerve is the trigeminal nerve?

1 - 2
2 - 4
3 - 5
4 - 7

A

3 - 5

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12
Q

The trigeminal nerve is cranial nerve V (5) is derived from the 1st pharyngeal arch and is the largest of all the cranial nerves. What functions does this cranial nerve have?

1 - sensory only of the face
2 - motor only of mastication muscles
3 - both of the above
4 - none of the above

A

3 - both of the above

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13
Q

What is the trigeminocervico complex?

1 - CN V (5) meets cervical vertebrae 1
2 - CN V (5) synapses in same nucleus as cervical vertebrae 1
3 - CN V (5) synapses in same nucleus as cervical vertebrae 1 and 2
4 - CN V (5) synapses in same nucleus as cervical vertebrae 1-3

A

4 - CN V (5) synapses in same nucleus as cervical vertebrae 1-3

  • sensory only from CV V (5)
  • this essentially means any sensory information from cervical vertebrae 1-3 can revert pain to the head causing a headache
  • region of the brain receives nociceptive stimulus
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14
Q

The trigeminocervico complex is a nucleus where CN V (5) synapses in same nucleus as cervical vertebrae 1-3 for sensory receptors only. Where is this located?

1 - cerebellum
2 - brain stem
3 - pons
4 - medulla oblongata and upper cervical spine

A

4 - medulla oblongata and upper cervical spine

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15
Q

Which of the following is not part of the trigeminal nerve?

1 - ophthalmic
2 - maxillary
3 - accessory
4 - mandibular

A

3 - accessory

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16
Q

The spinal trigeminal nucleus is a nucleus in the medulla that receives information about deep/crude touch, pain, and temperature from the ipsilateral (same side) face. Which of the following is important for pain and temperature sensations?

1 - Pars oralis
2 - Pars interpolaris
3 - Pars caudalis

A

3 - Pars caudalis

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17
Q

Which of the following are typical triggers for developing a migraine?

1 - tiredness, stress, dehydration
2 - alcohol
3 - combined oral contraceptive pill
4 - cheese, chocolate, red wines, citrus fruits
5 - menstruation
6 - bright lights
7 - all of the above

A

7 - all of the above
Remember the mnemonic CHOCOLATE:

C = chocolate
H = hangovers
O = orgasms
C = cheese/caffeine
O = oral contraceptive
L = lie-ins
A = alcohol
T = travel
E = exercise

18
Q

Migraines are a form of primary headaches, which essentially means the cause is unknown. Do migraines typically present unilaterally or bilaterally?

A
  • unilaterally
19
Q

Which of the following locations would the main symptom of a migraine be felt?

1 - on one side of the face
2 - around the eye on one side of the face
3 - across the top of the forehead
4 - all of the above

A

1 - on one side of the face

20
Q

Migraines are a form of primary headaches, which essentially means the cause is unknown. Which of the following do migraines NOT typically present with?

1 - severe, bilateral, throbbing headache
2 - nausea, photophobia (sensitive t light) and phonophobia (fear of sound)
3 - can last up to 72h
4 - patients typically stay in dark and quiet rooms
5 - auras can be or not be present
6 - stiff neck
7 - vary 1-2/month or 1/year

A

1 - chronic, bilateral, throbbing headache

  • typically migraines are unilateral
21
Q

A migraine aura is something that you experience when having a migraine. which of the following is true?

1 - can be visual only
2 - can be auditory only
3 - can be motor or sensory
4 - all of the above

A

4 - all of the above

  • most common is visual, and it is completely reversible
  • builds up over time and can last up to 60 minutes
  • more common in older patients, but no headaches
22
Q

An aura is when there are visual changes that are associated with migraines. What visual symptoms can be experienced in an aura?

1 - Sparks in vision
2 - Blurring vision
3 - Lines across vision
4 - Loss of different visual fields
5 - all of the above

A

5 - all of the above

23
Q

Auras typically occur prior to a migraine and can include visual (most common), auditory, motor and sensory aspects. Typically how long can the auras last for?

1 - <10 minutes
2 - <40 minutes
3 - <60 minutes
4 - <2 hours

A

3 - <60 minutes

24
Q

How long do migraines typically last?

1 - 4-72 hours
2 - 15-180 minutes
3 - 30 minutes to 1 week
4 - >1week

A

1 - 4-72 hours

25
Q

When migraines are present are they continuous or episodic?

A
  • episodic
  • typically throbbing unilaterally, but can be bilateral
  • feels like someone is drilling on the side of your head
26
Q

Overuse of medication can present in a similar way to migraines. Which of the following are present in migraines that helps distinguish migraines from medication overuse in headaches?

1 - occurrence of headache
2 - duration of the migraine
3 - nausea and vomiting
4 - gender

A

3 - nausea and vomiting
- both are present in migraines

27
Q

When performing a history on a patient with a headache, is an increase in the headaches symptoms when performing the Valsalva bad?

A
  • bad
  • indicates a mass or increased fluid overload in the cranial cavity
  • Valsalva is an increase in pressure with a closed glottis
28
Q

When performing a history on a patient with a headache, which of the following is NOT typically a red flag?

1 - patient wakes up with headache
2 - change in character
3 - age of onset
4 - sudden onset (thunderclap)
5 - focal neurological deficits
6 - constitutional symptoms (fever, meningism, rash, weight loss)

A

1 - patient wakes up with headache
- RED FLAG if it wakes the patient whilst they are asleep

29
Q

When examining a patient, all of the following are RED FLAGS except which one?

1 - patient appears sick-appearing, skin changes
2 - evidence of trauma
3 - altered cognitive state
4 - ocular: hyphema, pupil non-reactivity, optic disc swelling, proptosis, restricted eye movements
5 - meningism
6 - weight loss
7 - focal neurological findings (eg limb weakness)

A

6 - weight loss

30
Q

Of the following, which is most likely to trigger a migraine?

1 - dehydration and stress
2 - food and weather
3 - cigarettes and alcohol
4 - medications

A

2 - food and weather

31
Q

When diagnosing a migraine if the patient has no aura, how many migraines lasting 4-72h should a patient have had?

1 - >3
2 - >5
3 - >8
4 - >12

A

2 - >5

32
Q

When diagnosing a migraine if the patient has no aura, patients should have >5 migraines lasting 4-72h with nausea or vomiting. They should also have how many of the following?

  • unilateral painFred
  • pulsing pain
  • impairs ADL
  • photophobia/phonophobia

1 - >2
2 - >3
3 - all 4

A

1 - >2

33
Q

In addition to aura, which of the following occurring would suggest that the patient is having a migraine over tension headaches and cluster headaches?

1 - ipsilateral (same side) autonomic features)
2 - no features at all (including aura)
3 - aura, vomiting and nausea
4 - none of the above

A

3 - aura, vomiting and nausea

34
Q

Following a migraine, which of the following symptoms are unlikely to occur?

1 - fatigue
2 - tired
3 - lacrimation and ptosis
4 - difficulty concentrating
5 - stiff neck

A

3 - lacrimation and ptosis
- this commonly occurs in cluster headaches

35
Q

What is typically the 1st line treatment patients with migraines are given as part of abortive approach?

1 - paracetamol
2 - lifestyle advice
3 - NSAIDs
4 - Triptan (serotonin agonist)

A

2 - lifestyle advice
- adequate sleep, hydration, exercise, cognitive behavioural therapy, biofeedback

36
Q

If lifestyle advice fails in patients with migraines, which of the following can then be prescribed next as part of abortive approach?

1 - paracetamol
2 - aspirin
3 - NSAIDs
4 - Triptan (serotonin agonist)

A

1 - paracetamol
- then it would be aspirin and NSAIDs
- if these fail then we can use:

+ Triptan (eg sumatriptan, zolmitriptan)
+ Dopamine agonists (metoclopramide, prochlorperazine)
+ Monoclonal antibodies
+ Nerve block injections

37
Q

Should opioids ever be prescribed for the acute management of patients with migraines?

A
  • no
38
Q

What is typically the 1st line treatment patients with migraines are given as part of a preventative approach?

1 - Amitriptyline
2 - Lifestyle advice
3 - Propranolol
4 - Topiramate

A

2 - Lifestyle advice

39
Q

If lifestyle advice fails in patients with migraines, which of the following can then be prescribed next as part of preventative approach?

1 - Amitriptyline
2 - Lifestyle advice
3 - Propranolol
4 - Topiramate

A

4 - Topiramate
- GABA agonist
- AMPA antagonist

  • combined they block neuronal excitability that is causing migraines
40
Q

Which of the following would be a suitable differential for a patient with suspected migraine?

1 - cluster/tension headache
2 - cervical spondylosis
3 - intracranial pathology
4 - increased BP
5 - TIAs
6 - sinusitis/otitis media
7 - all of the above

A

7 - all of the above

41
Q

Patients who are menstruating may experience a menstruating migraine. Typically how long can this last during the menstrual cycle?

1 - whole 28 days
2 - >15 days
3 - <15 days
4 - 2-3 days

Prevention –
fovatriptan 2.5mg bd for 2/7 before attack expected until 3/7 after bleeding stops
Or zolmitriptan 2.5mg 2-3 x day as above
Oestrogen supplementation – but may cause rebound

A

4 - 2-3 days
- typically occurs in 2/3 menstrual cycles

42
Q

Patients who are menstruating may experience a menstruating migraine. Typically this last 2-3 days of the menstrual cycle, and occurs in 2/3 of cycles. Which 2 of the following medications can be used to prevent menstruating migraines?

1 - fovatriptan (inhibit cranial vasodilation)
2 - zolmitriptan (serotonin receptor agonist and inhibit vasodilation)
3 - verapamil (induces vascular vasodilation)
4 - B-blockers (slows heart rate and reduces brain oxygen requirements)

A

1 - fovatriptan (inhibit cranial vasodilation)
2 - zolmitriptan (serotonin receptor agonist and inhibit vasodilation)

C. Year 3 MLA Neurology/Behaviour Conditions/Diseases (28 decks)

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