Neurology - Migraines Flashcards
Which demographic is most commonly affected by migraines?
Women more often than men; most common in teenagers and young adults
How are migraines categorised?
- Migraine without aura
- Migraine with aura
- Silent migraine
- Hemiplegic migraine
What are the five stages of migraine?
- Premonitory or prodromal stage
- Aura
- Headache stage
- Resolution stage
- Postdromal or recovery phase
How long do migraines last?
4-72 hours
What are the typical features of migraines?
- Unilateral
- Moderate-severe intensity
- Pounding or throbbing nature
- Photophobia
- Phonophobia
- Osmophobia
- Aura
- Nausea and vomiting
What are common visual symptoms of aura?
- Sparks in the vision
- Blurred vision
- Lines across the vision
- Loss of visual fields
How can sensation auras present?
Tingling or numbness
Dysphasia (difficulty speaking)
What is the main feature of hemiplegic migraines?
Hemiplegia (unilateral limb weakness)
Can also have ataxia and impaired consciousness
Can mimic stroke or TIA
What is familial hemiplegic migraine?
Autosomal dominant genetic condition characterised by hemiplegic migraines that run in families
What are common migraine triggers?
- Stress
- Bright lights
- Strong smells
- Certain foods
- Dehydration
- Menstruation
- Disrupted sleep
- Trauma
What are some acute management strategies for migraines?
- Dark, quiet room
- Sleeping
What are some medical options for acute migraine attacks?
- NSAIDs (e.g., ibuprofen, naproxen)
- Paracetamol
- Triptans (e.g., sumatriptan) take as soon as migraine starts
- Antiemetics (e.g., metoclopramide, prochlorperazine)
Opioids not used, can make it worse
What mechanisms do triptans use to alleviate migraines?
- Cranial vasoconstriction
- Inhibiting pain signal transmission
- Inhibiting release of inflammatory neuropeptides
5HT -1B and 1D agonists
What are the contraindications for triptans?
- Hypertension
- Coronary artery disease
- Previous stroke, TIA, or myocardial infarction
What role does a headache diary play in migraine management?
Helps identify triggers and assess treatment response
List some usual prophylactic medications for migraines
- Propranolol
- Amitriptyline
- Topiramate
What specialist options are available for migraine prophylaxis?
- Pizotifen
- Candesartan
- Sodium valproate
- Monoclonal antibodies (e.g., erenumab, fremanezumab)
What are some alternative options mentioned for migraine prophylaxis?
- Cognitive behavioural therapy
- Mindfulness and meditation
- Acupuncture
- Vitamin B2 (riboflavin)
What can be used for menstrual migraines?
Phophylactic triptans
- Frovatriptan
- Zolmitriptan
Symptoms tend to be 2 days before until 3 days after mensutration, regular triptans can be used
How do migraines typically change with age?
Tend to become less frequent and severe or stop altogether with time
Particularly after menopause
What is the relationship between migraines and stroke risk?
Migraines are associated with a slightly increased risk of stroke, particularly with aura
