Migraines Flashcards
Are the scalp, sinuses, meninges, pail arteries or major vessels sensitive to pain?
Yes
Are the ventricles, choroid, parenchyma or small veins sensitive to pain?
No
What area of the midbrain can be stimulated to induce migraine type pain?
The Dorsal Raphe Nucleus
How does a Common Migraine (Migraine without Aura) present?
- Unilateral HA
- Deep ache, throbbing
- Phonophobia, photophobia, nausea and vomiting
- Worse with Activity
What disorder presents the same as a Common Migraine but has Auras?
Classic Migraine
Which disorder presents with dramatic auras that resemble a stroke?
Complicated Migraine
Which disorder presents with initial vertigo, ataxia, dysathria and diplopia followed by throbbing occipital pain?
Basilar Migraine
What is a Bickerstaff’s Migraine?
A dramatic basilar migraine that begins with total blindness, followed by ataxia, vertigo, dysarthria and tinnitus
What are common triggers for migraines?
- Wine
- Foods (Chocolare, cheese, MSG, Nitrates)
- Hunger
- Poor sleep hygiene
- Stress
What are abortive therapy options for migraine?
- NSAIDs
- Triptans and Ergots
- Dopamine Antagonists
- Combo drugs
Which Triptan is fast acting?
Sumatriptan
Which Triptan is long acting?
Frovatriptan
What are potential Prophylactic therapies for migraines?
- Beta Blockers
- Calcium Channel Blockers
- TCAs
- Anticonvulsants
- 5HT Drugs
Which migraine prophylactic would you use for a patient with HTN?
Beta Blocker
Which migraine prophylactic would you use for a patient having trouble sleeping?
TCA (Amitriptyline)
Which migraine prophylactic would you use for kids?
5HT Drug (Cyproheptadine)
What are the symptoms of a Cluster Headache?
- Severe Unilateral Stabbing Pain
- Lacrimation, Miosis, Ptosis and Eyelid Edema
- Rhinorrhea/congestion
- Circadian Rhythm
- Perspiration
What is the acute treatment of a cluster headache?
- Oxygen
2. IV Sumatriptan
What are the prophylactic options for Cluster Headaches?
- Prednisone
2. Calcium Channel Blockers (Verapamil is first line)
What is the most prevalent HA disorder?
Tension Headaches
Which disorder presents with squeezing around the head and light OR sound sensitivity without nausea/vomiting?
Tension Headaches
What are non-pharmacological treatment options for tension HAs?
- Stress Reduction
- Biofeedback
- CBT
- Sleep Hygiene
What are pharmacological options for tension HAs?
- Acetaminophen
2. NSAIDs
What is the prophylactic treatment for tension HAs?
- TCAs
2. Antiepileptics
Which patients usually get IIH?
Overweight young girls
Which drugs cause IIH?
- Tetracyclines
- Contraceptives
- Hypervitaminosis A
Which disorder is not worsened by physical activity?
Tension Headaches
Which disorder is worse with coughing, sneezing and moving into a supine position?
IIH
When is an MRI warrented?
- IIH
2. New, acute onset HA that have an ABNORMAL neuro PE
Which disorder improves with an LP?
IIH
What are the MRI findings of an IIH?
- Small Ventricles
- Large Optic Nerve Sheath
- Empty Sella
What is the opening pressure of IIH?
Greater than 250mmH20
What are the non-pharm treatment options for IIH?
- Weight loss
2. Stop causitive drugs
Which drugs help IIH?
- CA Inhibitors (Acetazolamide and Topiramate)
Shunt placement or optic nerve fenestration may be options for which condition?
IIH
Which condition is caused by cell mediated immunity?
Giant Cell Arteritis
Which conditions may lead to permanent vision loss?
IIH and GCA
How does GCA present?
- Progressive unilateral temporal throbbing
- Jaw claudication
- Joint Pain
- Transient monocular vision loss
- Neck, shoulder or torso pain
Which disorder is typically only seen in patients older than 50?
GCA
What is the treatment for GCA?
High dose steroids
