Migraines Flashcards

1
Q

What are migraines

A

complex neurological condition causing episodes/ attacks of headaches and associated symptoms

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2
Q

What are the four types of migraine

A
  • migraine without aura
  • migraine with aura
  • silent migraine (aura but no headache)
  • hemiplegic migraines
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3
Q

What are the 5 stages of migraine?

A
  • prodrome
  • aura
  • headache
  • resolution stage
  • postdromal or recovery stage
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4
Q

What are the typical features of a migraine?

A
  • usually unilateral
  • moderate- severe intensity
  • pounding/ throbbing
  • photo/ phonophobia
  • osmophobia (strong smells)
  • aura
  • nausea and vomiting
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5
Q

What can aura affect

A
  • vision
  • language
  • sensation
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6
Q

How does aura affect vision

A
  • sparks
  • blurred vision
  • lines across vision
  • loss of visual fields
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7
Q

How does aura affect sensation

A

tingling or numbness

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8
Q

How does aura affect language

A

dysphasia

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9
Q

What is the main feature of hemiplegic migraines

A

unilateral limb weakness (hemiplegia) therefore mimics stroke/ TIA

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10
Q

What are two other features of hemiplegic migraines

A
  • ataxia- loss of coordination
  • impaired consciousness
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11
Q

What is the genetics of hemiplegic migraines

A

autosomal dominant

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12
Q

What are common triggers of migraines

A
  • stress
  • bright light
  • strong smells
  • certain foods (chocolate, cheese, caffeine)
  • dehydration
  • menstruation
  • disrupted sleep
  • trauma
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13
Q

What is non medical acute management of migraines

A

patients often develop strategies eg sleeping in a dark, quiet room

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14
Q

Medicines for an acute migraine attack

A
  • NSAIDs
  • paracetamol
  • triptans (eg sumatriptans)
  • antiemetics
    opiates NOT used- may make it worse
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15
Q

What are triptans used for in migraines

A

to abort migraine attacks when they start to develop

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16
Q

What type of drug are triptans

A

5- HT receptor agonists- bind to stimulate serotonin receptors

17
Q

Whats the mechanism of action of triptans

A
  • cranial vasoconstriction
  • inhibit transmission of pain signals
  • inhibiting release of inflammatory neuropeptides
18
Q

Contraindications of triptans

A

related to vasoconstriction
- HTN
- coronary artery disease
- stroke
- TIA
- MI

19
Q

Non medical migraine prophylaxis

A

headache diary and avoiding triggers

20
Q

Medical migraine prophylaxis

A
  • propanolol ( non selective beta blocker CI in asthma)
  • amitriptyline (tricyclic antidepressant)
  • topiramate (teratogenic and very effective contraception required)