Migraines & Headaches Flashcards by Harroop Bola

What are three main migraine attacks?

1) Pain
2) Pain and focal symptoms
3) Focal symptoms

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What are the five main phases of migraines?

Prodrome
Aura
Headache
Resolution Recovery

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What is the prodrome phase of a migraine?

This is the predecessor phase for migraines, upon a trigger these symptoms precede the development of headache and migraine-like features.

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What symptoms are associated with a prodrome headache?

Changes in mood
Urination 
Fluid retention
Food craving 
Yawning

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What are the typical features of a migraine aura?

Visual (Scintillating scotomas and blindspots) and sensory disturbances ( Numbness/paraesthesia)

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What are the two types of visual disturbances in patients experiencing a migraine aura?

Positive signs: Scintillating scotomas.

Negative signs: Blind spots and visual occlusions

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What is a scintillating scotoma?

A positive visual aura sign in individuals experiencing a migraine.
There is a zig-zag crescent progressively expanding towards the periphery as the electrical depression grows across the cerebral and visual cortex

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What sensory disturbances are experienced in individuals with an aura migraine?

Numbness
Paraesthesia
Weakness
Speech arrest

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Scintillations and blind spots are associated with which face of a migraine?

Aura

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Which phase proceeds the aura phase of migraine?

Headache: Head and body (pulsating hemicranial), nausea and photophobia (irritation to light).

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Photophobia is associated with which migraine phase?

Headache phase

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Which phase proceeds the headache phase of a migraine?

Resolution phase

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What is the resolution phase of a migraine?

This periods alleviates the associated symptoms and pain, enabling patients to rest and sleep.

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Which is the final phase of a migraine?

Recovery

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What is the recovery phase of a migraine?

Sensitivity to the migraine effects, there are associated mood disturbances, food intolerances and the feeling of being hungover.

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What is the typical duration of a migraine?

3-12 hours

What class of drug is metoclopramide in terms of migraine treatment?

Anti-emetic and a pro-kinetic agent

Why is metoclopramide used for migraine treatment?

As a pro-kinetic agent it stimulates peristalsis (gastric paresis in patients with migraines), therefore reducing the sensation of nausea and vomiting.

Soluble preparations are prepared to aid absorbed

What are the common forms of pharmacological treatment in migraine patients?

Aspirin/Ibuprofen (Non-steroidal) and paracetamol and metoclopramide

Triptans

What is the mechanism of triptans?

Triptans are selective 5HT1 receptor agonists, inducing vasoconstriction within pain-sensitive intracranial vessels.

Which combination of drugs results to greater recovery outcomes in patients with a migraine?

Synergise with non-steroidal (ibuprofen) with triptan.

What preparations are available for triptans?

Tablets, melts, nasal sprays, s/c injections

Why should opioids be prescribed with cauation?

Opioids exhibit an analgesic abuse potential. There are fluctuations with the associated headache pain, thus reoccurrence of headaches encourages individuals to take more painkillers.

How can a transcranial magnetic stimulation alleviate the symptoms of a migraine?

TMS interrupts complex networks that trigger and perpetuate migraine, which is caused by spreading electrical depression across the cerebral cortex.

What is a possible explanatory reason for migraineurs having sensitive heads?

There is a genetic predisposition within individuals resulting in an increased sensitivity to environmental triggers, since overstimualtion of the cortex

What can migraineurs do to avoid migraines?

Identify particular triggers for a migraine, and avoid them. - Identify any dietary triggers (Citrus, dairy chocolate, alcohol) - Identify any changes in the environment including light, ventilation and barometric pressure - Dehydration (recommended to drink 2L water a day - Avoid caffeinated drinks - Avoid stress (individuals should plan accordingly their daily activities to minimise stress). - Never skip meals (avoid takeaways and ready meals). Preservatives could trigger migraines.

What over the counter treatment can be used for migraines as a prophylaxis?

Feverfew, coenzyme Q10, riboflavin, magnesium, EPO, nicotinamide

Which TCA can reduce the severity and frequency of headaches?

Amitriptyline at 7pm

Which migraine prophylaxis is effective?

Pizotifen (Serotonin antagonists)

How does erenumab antibodies work when treating patients with migraines?

Disables calcitonin gene-related peptides or receptor (CRGP mAbs)

What are tension-type headaches?

Tight muscles around head and neck bilaterally.

Which types of pharmacological interventions are preferred in patients with tension type headaches?

NSAIDs

What are the acute forms of treatment for individuals with a cluster headache?

Inhaled oxygen, oxygen inhibits neuronal activation in the trigeminocervical complex

Which complex is inhibited by oxygen therapy in patients with cluster headached?

Trigeminocervical complex

Which drug is typically prescribed in individuals with cluster headaches?

Sumatriptan

What is the typical duration of a cluster headache?

45 minutes - 3 hours

Which type of headache is mainly concerned with nausea and vomitting?

Migraines

What type of headache is associated with pulsating hemicranial pain?

Migraines