Condition- Migraine Flashcards
What is a migraine?
Severe episodic headache usually with a genetic predisposition. May have a prodrome of neurological origin (aura) and is associated with systemic disturbance
What are the three classifications of migraines?
- Migraine with aura (classical migraine)
- Migraine without aura (common migraine)
- Migraine Variants (e.g.familial hemiplegic, opthalmoplegic)
Which gender is more likely to get migraines?
Females
List some of the risk factors which trigger the onset of migraines?
CHOCOLATE
- Cheese
- Oral contraceptives
- Caffiene withrdrawal
- Alchohol
- Anxiety
- Travel
- Exercise
List some of the presenting symptoms of migraines
- Headaches
- Photophobia/ Phonophobia
- Nausea/ vomitting
- Aura
Describe some aura’s experienced by migrane sufferers
- Visual auras:
- Flashing lights
- Spots
- Blurring
- Zigzag lines
- Blind spots (scotomas)
- Sensory auras:
- Tingling/ numbness in limbs
- Speech auras:
- Dysphasia
- Dysarthria
- Timing: occurs during the hour before the onset of the headache
Describe the character of the headaches caused by migraines?
- S: often unilateral
- O: gradual
- C: Throbbing, pulsatile
- A: nausea/ vom, photo/phonophobia, auras
- T: episodes last 4-72hr
- E: CHOCOLATE triggers (cheese, Oral contraceptive, alcohol), FHx
- S: impairs routine activity
Why mights diagnostic tests be used when investigating a patient with migraines? Which tests can be used?
- To exclude other sinisters causes of headaches
- Bloods, CT/ MRI, lumbar puncture
Which mnemonic can be used to raise your suspicions of alternative more sisnister causes of headaches?
- Systemic Symptoms: fever, weight loss
- Neurological symptoms/ abnormal signs: confusion, impaired alertness or consciousness
- Onset: sudden, abrupt
- Older: new-onset, progressive, over 50yrs
- P 4:
- Pattern change (increased frequency)
- Papilloedema
- Precipitating factors (valsalva, etc)
- Positional aggravation
Describe the treatment given to relieve acute migraines
- Conserevative management: trigger avoidance
- NSAIDs+ Paracetamol
- Sumitriptan (5-HT1 antagonist)
- (Metoclopromide (anti-emetic))
Which medications could be given prophylactically to prevent migraines?
- 1st line: Beta-blockers (propanalol) or Topiramate (anti-epileptic)
- 2nd line: Amitriptyline (TCA)
- Menstrual migraines controlled by contraceptive pill
- Advice: avoid triggers
What are some of the complications of migraines?
- status migrainosus- migraine lasting more than 72hrs (look for analgesia overuse because it can cause headaches)
- Depression
- Migrainous infarction- RARE
