Migraines

Question 1

Migraines are the most common cause of r______ h_____

Answer 1

recurrent headaches

Question 2

Migraines are episodes of r_____ t______ h_____ with or without an a_____, often with vision changes

Answer 2

recurrent throbbing headaches
aura

Question 3

What group of people are migraines most common in?

Answer 3

Women under 40

Question 4

What are triggers for migraine?

Answer 4

CHOCOLATE

Chocolate
Hangovers
Orgasms
Cheese
Oral contraceptives
Lie-ins
Alcohol
Tumult (loud noise)
Exercise

Also stress, strong smells, bright lights, caffeine, menstruation, dehydration, disrupted sleep, trauma

Question 5

What is prodrome?

Answer 5

An early symptom indicating the onset of a disease/illness

Question 6

What can the prodromal stage involve for migraines?

Answer 6

Change in mood, yawning or fatigue days before an attack

Question 7

What is an aura?

Answer 7

Can affect vision, sensation or language. Visual changes most common.
Comes before headache, can last up to an hour.

Question 8

What can visual changes be in aura stage of migraine?

Answer 8

Can include seeing zig-zag lines, flashing lights, hallucinating, temporary blind spots and blurred vision

Question 9

How long does the throbbing headache in a migraine last?

Answer 9

4-72 hours

Question 10

What are symptoms of migraine

Answer 10

Migraines classed as atleast 2 of:
Unilateral pain
Throbbing
Motion sickness
Moderate-severe intensity

with either:
N+V or photophobia

and a normal neuro exam

Question 11

How do you diagnose a migraine?

Answer 11

Through symptoms, unless another pathology is suspected

Question 12

What is used to abort an acute migraine when is starts developing?

Answer 12

Oral triptan (eg sumatriptan)

5-HT receptor, bind to and stimulate serotonin receptors. Cause cranial vasoconstriction, inhibit pain signals transmitting and inhibit release of inflammatory neuropeptides).

Question 13

If a triptan is given and the migraine attack resolves and then reoccurs, can another dose of triptan be taken?

Answer 13

No, not for the same attack

Question 14

What can be used to relieve the headache in a migraine?

Answer 14

NSAIDs (eg ibuprofen)
Paracetamol

Question 15

What prophylaxis is there for migraines?

Answer 15

Non-selective beta-blocker like propranolol
or Amitriptyline (tricyclic antidepressant)

If asthmatic: anticonvulsant like topiramate

Question 16

True or false: opiates should be avoided for treating migraines

Answer 16

True
Risk of dependence and worsens nausea

Question 17

Name an antiemetic that could be considered if N+V with migraine?

Answer 17

metoclopramide

Question 18

What are the 5 stages of migraine?

Answer 18

Prodromal stage
Aura
Headache
Resolution
Postdromal stage

Question 19

What is a ‘silent migraine’?

Answer 19

Migraine with aura but without a headache

Question 20

What is a hemiplegic migraine?

Answer 20

Main feature is hemiplegia (unilateral limb weakness)

Can include ataxia and impaired consciousness.

Can mimic a stroke or TIA so need to exclude first.

Question 21

Familial hemiplegic migraine is what kind of genetic condition?

Answer 21

autosomal dominant

Question 22

Migraines are associated with a slightly higher risk of _____ especially when occur with aura.

Answer 22

Stroke

Therefore contraindicated for contraceptive pill as also increases risk of stroke

Question 23

What happens to the pattern of migraines?

Answer 23

Can be related to menstrual cycle.

Over time tend to become less frequent and severe or stop altogether with time, particularly with menopause