Random Migraine Things Flashcards
what is the vasogenic theory of migraines
afferent sensory fibers get activated; these innervate meningeal +/or cerebral vessels
how does the vasogenic theory explain auras and the headache?
aura: internal carotid vasoconstriction
HA: rebound vasodilation of external carotid
what is the neurogenic theory of migraines
trigeminal nerve fibers get activated; these innervate the meninges and cause neurogenic inflammation
what does the neurogenic theory help explain?
N/V, photophobia, hallucinations, etc. symptoms
what neurotransmitter plays a role in vasoconstriction and inflammation
serotonin
what is a scintillating scotoma
a visual change with an aura
are complex migraines common
no
what is a complex migraine
a prolonged aura with neurologic deficits lasting from 1h to a week
can a complex migraine cause permanent neuro deficits?
yes, even though there is no vessel occlusion
how do you treat mild complex migraines?
ASA or NSAIDS early
what is abortive tx for complex migraines?
ergotamine
cafergot-ergotamine-caffeine
tryptans
what drug class should you AVOID with migraines?
opioids
what drug class are the tryptans
serotonin agonists
what do you rx for severe intractable migraine HAs?
subQ dihydroergotamine with anti-emetic, an injectable narcotic, indomethacin to prevent relapse, and steroids in the short-term
(seems a bit excessive, eh?)
5 drug classes you and ppx migraines with?
BB TCAs CCBs anticonvulsants botulism
what is the MC type of HA?
tension
do tension HAs worsen with physical activity?
NO
do tension headaches have N/V?
NO
what other sx might you have with a tension headache?
poor concentration, stress, fatigue, sensitive to noise and glare
who gets cluster HA/migrainous neuralgia?
usually men in their 20s-50s
what syndrome is associated with cluster HA?
horner’s syndrome
what is the timing of cluster HA?
lasts 15min-2h
recurs daily
what is the main trigger of cluster HA?
alcohol
how do you treat cluster HA?
100% O2 for 1-2h
ergotamine, sumatryptan
which type of HA occurs more than 15d/mo for 3mo or more
chronic daily HA
what is a chronic daily HA most commonly due to
med overuse
what type of tumor makes up 50% of intracranial mass lesions?
gliomas
is a brain tumor a sharp or dull pain
dull
where does the pain from a tumor occur?
bifrontal or occipital
when do HAs from tumors usually begin?
in AM
are HAs from tumors worse with exertion/changing posture?
yes
is N/V associated with a HA from a brain tumor?
maybe
what should make you start considering a brain tumor in a patient with a HA?
NEW ONSET headache at 45+ years with other neurological/psychological findings
