Migraines

Question 1

What are the 4 types of migraines?

Answer 1

1) migraine without aura
2) migraine with aura
3) silent migraine
4) hemiplegic migraine

Question 2

What is a silent migraine?

Answer 2

Migraine with aura but without the headache

Question 3

Give the 5 stages of migraines:

Answer 3

1) prodromal (subtle, early symptoms e.g. fatigue)
2) aura (up to 60 mins)
3) headache (4-72 hours)
4) resolution
5) post-dronal (recovery)

Question 4

Give 8 symptoms associated with migraines:

Answer 4

1) unilateral pain
2) pounding/ throbbing character
3) visual changes
4) photophobia
5) osmophobia
6) phonophobia
7) vomiting
8) nausea

Question 5

What is osmophobia?

Answer 5

discomfort with loud noises

Question 6

Give 6 potential features of a migraine aura:

Answer 6

1) sparks in the vision
2) blurred vision
3) lines across the vision
4) loss of visual fields (scotoma)
5) dysphagia
6) tingling or numbness

Question 7

Give 3 presentations associated with hemiplegic migraines:

Answer 7

1) unilateral limb weakness (hemiplegia)
2) ataxia (loss of coordination)
3) impaired consciousness

Question 9

What genetic condition is characterised by hemiplegic migraines?

Answer 9

familial hemiplegic migraine disease

Question 10

What is the inheritance path for familial hemiplegic migraine disease?

Answer 10

autosomal dominant

Question 11

Give 8 triggers of migraines:

Answer 11

1) stress
2) bright light
3) strong smells
4) chocolate, cheese, caffeine
5) dehydration
6) menstruation
7) disrupted sleep
8) trauma

Question 12

Give 4 pharmaceutical options for acute migraines:

Answer 12

1) NSAIDs (ibuprofen, naproxen)
2) paracetamol
3) triptans
4) antiemetics for vomiting

Question 13

Give 2 examples of antiemetics used in migraine treatment:

Answer 13

1) metoclopramide
2) prochlorperzine

Question 14

What triptan is given for acute migraines?

Answer 14

sumatriptan

Question 15

True or false: opiates can make migraines worse

Answer 15

True

Question 16

What receptor do triptans act on?

Answer 16

5-HT receptor agonists (especially 5HT1B and 5-HT1D)

Question 17

Give 3 mechanisms of triptan action that make them effective in treating migraines:

Answer 17

1) stimulating cranial vasoconstriction
2) inhibiting the transmission of pain signals
3) inhibiting the release of inflammatory peptides

Question 18

When should triptans be taken for acute migraines?

Answer 18

as soon as the migraine starts (should halt the attack)

Question 19

Give 3 contraindications for triptan use:

Answer 19

1) hypertension
2) coronary artery
3) previous stroke/ TIA

Question 20

Give 3 drugs used in migraine prophylaxis:

Answer 20

1) propanolol (non-selective beta blocker)
2) amitriptyline (tricyclic antidepressant)
3) topiramate

Question 21

True or false: topiramate is highly teratogenic

Answer 21

True

Question 22

Name two triptans that can be used for menstrual migraine prophylaxis:

Answer 22

1) frovatriptain
2) zolmitriptan

Question 23

Why should a female patient who suffers migraines avoid the combined oral contraceptive pill?

Answer 23

both are risk factors for stroke