Random Migraine Things

Question 1

what is the vasogenic theory of migraines

Answer 1

afferent sensory fibers get activated; these innervate meningeal +/or cerebral vessels

Question 2

how does the vasogenic theory explain auras and the headache?

Answer 2

aura: internal carotid vasoconstriction
HA: rebound vasodilation of external carotid

Question 3

what is the neurogenic theory of migraines

Answer 3

trigeminal nerve fibers get activated; these innervate the meninges and cause neurogenic inflammation

Question 4

what does the neurogenic theory help explain?

Answer 4

N/V, photophobia, hallucinations, etc. symptoms

Question 5

what neurotransmitter plays a role in vasoconstriction and inflammation

Answer 5

serotonin

Question 6

what is a scintillating scotoma

Answer 6

a visual change with an aura

Question 7

are complex migraines common

Answer 7

no

Question 8

what is a complex migraine

Answer 8

a prolonged aura with neurologic deficits lasting from 1h to a week

Question 9

can a complex migraine cause permanent neuro deficits?

Answer 9

yes, even though there is no vessel occlusion

Question 10

how do you treat mild complex migraines?

Answer 10

ASA or NSAIDS early

Question 11

what is abortive tx for complex migraines?

Answer 11

ergotamine
cafergot-ergotamine-caffeine
tryptans

Question 12

what drug class should you AVOID with migraines?

Answer 12

opioids

Question 13

what drug class are the tryptans

Answer 13

serotonin agonists

Question 14

what do you rx for severe intractable migraine HAs?

Answer 14

subQ dihydroergotamine with anti-emetic, an injectable narcotic, indomethacin to prevent relapse, and steroids in the short-term
(seems a bit excessive, eh?)

Question 15

5 drug classes you and ppx migraines with?

Answer 15

BB
TCAs
CCBs
anticonvulsants 
botulism

Question 16

what is the MC type of HA?

Answer 16

tension

Question 17

do tension HAs worsen with physical activity?

Answer 17

NO

Question 18

do tension headaches have N/V?

Answer 18

NO

Question 19

what other sx might you have with a tension headache?

Answer 19

poor concentration, stress, fatigue, sensitive to noise and glare

Question 20

who gets cluster HA/migrainous neuralgia?

Answer 20

usually men in their 20s-50s

Question 21

what syndrome is associated with cluster HA?

Answer 21

horner’s syndrome

Question 22

what is the timing of cluster HA?

Answer 22

lasts 15min-2h

recurs daily

Question 23

what is the main trigger of cluster HA?

Answer 23

alcohol

Question 24

how do you treat cluster HA?

Answer 24

100% O2 for 1-2h

ergotamine, sumatryptan

Question 25

which type of HA occurs more than 15d/mo for 3mo or more

Answer 25

chronic daily HA

Question 26

what is a chronic daily HA most commonly due to

Answer 26

med overuse

Question 27

what type of tumor makes up 50% of intracranial mass lesions?

Answer 27

gliomas

Question 28

is a brain tumor a sharp or dull pain

Answer 28

dull

Question 29

where does the pain from a tumor occur?

Answer 29

bifrontal or occipital

Question 30

when do HAs from tumors usually begin?

Answer 30

in AM

Question 31

are HAs from tumors worse with exertion/changing posture?

Answer 31

yes

Question 32

is N/V associated with a HA from a brain tumor?

Answer 32

maybe

Question 33

what should make you start considering a brain tumor in a patient with a HA?

Answer 33

NEW ONSET headache at 45+ years with other neurological/psychological findings