Migraines And Emesis

Question 1

What is a headache often associated with

Answer 1

Aura- migrating visual or other sensory disturbance lasting up to an hour

Question 2

What is a migraine often preceded by

Answer 2

Prodromal signs- hyperactivity yawning food craving neck stiffness

Question 3

What does the pain in an migraine come from

Answer 3

Neurovascular?
Activation of Trigeminal nerve terminals on blood vessels (=nausea) pain transmitted from Trigeminal to Cortex
Brain arteriolar dilation and of temporal artery

Question 4

What do sensory nerves release in a migraine

Answer 4

CGRP and NO

Question 5

What are migraine diagnostic characteristics

Answer 5

2 or more : unilateral, pulsating, painful, aggravated my normal physical activity
Usually associated with : aura nausea photophobia and photophobia

Question 6

What are the main diagnostic subdivisions of a migraine

Answer 6

Without aura
Aura
Retinal

Question 7

What increased the risk of migraine

Answer 7

FDR

Morning

Question 8

Explain spreading depression

Answer 8

Sustained depolarisation associated with waves of metabolic over-stimulation followed by inhibition
Waves spread across surface of cortex disrupting local function - visual cortex =zigzags

Question 9

What is the therapy for migraines

Answer 9

acute - NSAIDS/analgesics ibruprofen paracetamol and diclofenac

TRIPTANS- 5HT1b and 5HT1d receptor agonists-construction of brain blood vessels and therefore inhibition of neuropeptide release

Question 10

What prophylaxis exists for migraines

Answer 10

Avoid known triggers
B-blockers 
Calcium channel blockers
Anticonvulsants
Pre-menstrual oestrogen

Question 11

For treatment resistant patients what is recommended

Answer 11

Acupuncture is gabapentin

Question 12

What Things accompany nausea

Answer 12

Cold sweat
Pallor
Salivation
Self absorption
Loss of gastric tons
Duodenal contractions
Reflux of intestinal context into stomach

Question 13

What is the sequence that leads to vomiting

Answer 13

Woeful sustained contraction of abdominal chest wall and diaphragm muscles, increase intra-gastric pressure, opening of cardioesophageal sphincter glottis and jaws

Question 14

Name seven causes of nausea and vomiting

Answer 14

Iatrogenic (chemo radio, opiates, antibiotics)
Motion sickness 
Pregnancy 
Poisoning 
Gastroenteritis
Meningitis and intracranial haemorrhage 
Bulimia nervosa

Question 15

What is the main vomiting centre input

Answer 15

Chemoreceptor trigger zone at the base of the forth ventricle has D2 5HT opioid and Ach NK1 receptors

Question 16

What alternative inputs are there to the vomiting centre

Answer 16

Area postrema 
Vagal gag reflex (5HT and NK1)
Vestibular system  ( m Ach and H1 Rs)
Gut 5HT3 
Sight of smell of vomit

Question 17

When would you induce vomiting

Answer 17

Poison in stomach
Swallow an emetic- ipecacuanha
Or induce gag reflex

Question 18

What drugs are used to control emesis most effectively

Answer 18

NK1 reception antagonism (aprepitant) because substance p is major output transmitter from vomiting centre

Question 19

What is used for motion sickness

Answer 19

H1 and 2 antagonists

Question 20

How is chemo therapy induced emesis controlled

Answer 20

Corticosteroids NK1 antagonist and 5HT3 antagonist

Question 21

How is nausea controlled

Answer 21

Mild sedation ( benzodiazepines) and anti-emetics

Question 22

Define a migraine

Answer 22

Painful pulsing headache typically lasting 4hrs-3days often unilateral with photophobia