Neurology\Migraines Flashcards
What patient populations are most prone to migraine headaches?
- women
- aged 30-39
- positive family history for migraines
What are the types of migraines?
- migraines with aura
- migraines without aura
- migraine variants
- retinal
- ophthalmoplegic
- familial hemiplegic migraines
Most common migraine
- migraine without aura (80%)
International Headache Society diagnositic criteria for migraine headaches
The headache must meet these three criteria:
- last between 4 and 72 hrs
- have two of the following
- unilateral
- pulsating
- aggravated by physical activity
- moderate to severe in intensity - Be associated with one of the follwing symptoms
- nausea/ vomiting
- photophobia/ phonophobia
What are examples of auras?
- auras are typically reversible and can include
- visua l (flickering lights, spots, lines, loss of vision)
- speech symptoms
What factors can trigger migraines?
- stress
- menstruation
- visual stimuli
- weather changes
- nitrates
- fasting
- wine
- sleep disturbances
- aspartame
What will migraine sufferers typically do to derease symptoms?
- Lie down in a quiet, dark room
What is the purpose of a headache diary?
- A diary helps indentify heache precipitating factors
- these factors may be avoidable altogether
- or patients may be able to time the use of prophylactic medications more appropriately e.g. just before menses
What are pharmacologic treatment options for migraine headaches?
- mild analgesics - ibuprofen, naproxen, diclofenac, aspirin, indomethacin and paracetamol
- triptans- sumatriptan, Zolmitriptan
- Ergots - ergotamine, dihydroergotamine
- antiemetics - metoclopramide
- Dexamethasone
When should triptans be avoided?
- familial hemiplegic migraines
- basilar migraine
- ischemic stroke
- ischemic heart disease
- Prinzmetal angina
- uncontrolled hypertension
- pregnancy
- monoamine oxidase inhibitor
- ergot use over the last 24 hours
What is the role of opioids in migraine treatment?
They should be reserved for patients with intractable migrained who are not responding to other arbotive treatments. Routine use can be habit forming and contribute to rebound headaches.
What are the indicaitons for preventive migraine therapy?
- frequent headaches ( > 4 per mnth)
- longlasting headaches (>12 hrs)
- headaches that cause significant disability
- contraindications
- refractory symptoms
- adverse events with acute medications
What medications are used to prevent migraines?
- beta-blockers - propanolol, metoprolol, atenolol
- calcium channel blockers - verapamil, nifedipine
- ACE inhbitors/angiotensin receptor blockers - lisinopril, candesartan
- antidepressants - amitriptyline, nortriptyline, mirtazapine
- Anticonvulsants - valproate, gabapentin, topiramate
