Migraines

Question 1

Migraine epidemiology

Answer 1

20% of F, 6% of M

Question 2

Aetiology of Migraine

Answer 2

Largely unknown
The headache phase is associated with vasodilation of extracranial vessels.
There is Fx –> suggests genetic predisposition
In F contraceptive pill seems to be trigger.
Cheese chocolate or red wine involvement is overestimated

Question 3

If a migraine is exacerbated by stress when would it start relative to the stress phase

Answer 3

after the period stress

Question 4

Clinical presentation of migraine

Answer 4

prodrome of malaise, irritability and behavioral change in may occur.

Numbness sensation spreading from part of body to the other lasting 20-30minz

if dominant hemisphere is involved speech could be affected

seeing zigzag lines that march the visual fields lasting 40minz, sometimes leaving a scotoma

Question 5

Clinical presentation of classical migraine

Answer 5

in 20% Px preceded by aura

Question 6

Clinical presentation of common migraine

Answer 6

in 80% Px do not have aura

Question 7

Describe the headache involved in migraine

Answer 7

unilateral severe and throbbing with photophobia, phonophobia and vominting lasting 4-72hrs.

Exacebrated by movement.

Px usually seek a quiet and dark room

Question 8

Management of Acute Migraines

Answer 8

simple Analgesia - paracetamol or aspirin often with antiemetic (for the vomiting)

if severe consider triptans (5-HT agonists aid vasoconstriction of extracranial arteries)

Question 9

Prevention management of Migraines

Answer 9

try to identify and avoid exacerbating factors
If frequent consider:

CCB
propanalol
amitriptyline (tricyclic antidepressant)
or antiepeleptics (sodium valproate)
In F avoid oestrogen pill or HRT

Question 10

What iatrogenic causes of migraine are there

Answer 10

Medication overuse migraine
usually codeine and other opiate containing drugs
this is becoming more common

Question 11

What are cluster headaches

Answer 11

are a type of headaches that are less common than migraines.
5M:1F with onset usually in third decade

Question 12

Describe the headache involved in cluster headaches

Answer 12

severe unilateral periorbital pain with unilateral lacrimation, nasal congestion and conjunctival injection (clear red vessels of conjunctiva)
this can last 30-90 minz

occurs repeatedly over few weeks then stops for months and returns

Question 13

How to manage cluster Headaches

Answer 13

subcutaneus injection of triptan or inhalation of 100% oxygen

Question 14

Could cluster headaches be prevented

Answer 14

Prevention may be possible with the use of either

sodium valproate (antiepeleptic)
verapamil (CCB)
short courses of corticosteroids

Question 15

What are the differentials of migraines

Answer 15

Cluster or tension headaches

Question 16

What is tension headache

Answer 16

It is the commonest type of headaches

Question 17

Describe the headache involved in tension headaches

Answer 17

it is a constant generalised headache often radiating from occipital lobe (band like) .

Described as dull, tight, or pressure feeling.

Pain may continue for weeks but severity may very. Usually worsens as day goes on.

there is no photophobia or vomiting nor worse with movement

Question 18

Management of tension headaches

Answer 18

identifying and preventing triggers is key

analgesic management could worse headache why –>(analgesic headache)

Phsyio for Muscle relaxation and stress management