Evaluation of Patient with Headache Part 3 Flashcards
(64 cards)
When is the clinical onset of migraines?
Age 3 - 40; usually during puberty
What is the F:M ratio for acquiring migraines?
3:2 F:M
What is the likelihood to have a positive family history for migraines?
70%
On what chromosome are migraines probably associated with?
19
What is an aura?
Any transient neurologic disturbance lasting 15-30 minutes preceding the headache.
Ex- Visual - blurry, cloudy, scotomata, teichopsia, flashes of light, metamorphopsia
-aphasia, vertigo, thick speech, tremor, unilateral numbness (that’s me!) or weakness, auditory or olfactory hallucinations
What is scotomata?
spots in front of eyes
What is teichopsia?
luminous appearance before the eyes with a zig-zag, wall outline
‘fortification spectrum’
‘scintillating scotoma’
What are the clinical features of a migraine with aura?
- aura ends as headache begins
- throbbing character
- onset is unilateral but may spread
- accompanied by nausea, vomiting, photophobia, sonophobia, pallor, tremors, perspiration and chills
What are some less common accompaniments with a migraine?
-constipation, diarrhea, cold extremities, local or general edema, speech difficulties
Rare- aphasia, extremity weakness
How long does a migraine with aura last?
4-24 hours
variant - status migrainosus»_space;>10 days
What premonitory features are present in 25% of patients who have migraines with aura?
- elation
- irritability
- depression
- hunger
- thirst
- drowsiness
What symptoms may follow the migraine with aura? Post-headache stage
- headache side is tender to touch
- brushing hair may be painful
- exhaustion
- physical effort or position of head may retrigger throbbing
- some may have euphoria
What might a patient suffer between migraines with aura?
-sudden sharp pains that last only a couple of seconds
‘Ice pick headaches’
Cephalgia fugax
Where does the vascular theory of migraine come from?
one patient who was kept conscious while having brain surgery and the neurosurgeon observed that vasoconstriction was taking place followed by vasodilation that accompanied the headache
What does vascular theory fail to explain?
- premonitory features
- some drugs that treat migraines have no effect on vasculature
- not supported by new blood flow studies (areas of diminished blood flow do not correlated to aura generated)
What is the serotonin theory?
spreading wave of abnormal neural activity that creeps across the cortex has been observed
- begins in the occipital lobe
- spread to involve most or all of the cerebral cortex
What are the most effective medications and which receptors are they active at?
Triptans
Receptors
- 5-HT1B
- 5-HT1D
What is the final common pathway for migrainous cephalgia?
5HT receptors
What are 3 atypical migraines?
- ophthalmoplegic migraine
- hemiplegic migraine
- basilar artery migraine
What are the clinical symptoms of a ophthalmoplegic migraine?
- cranial nerve III palsy
- paralysis of the extraocular muscles
- ptosis and pupillary asymmetry
- can last for days/weeks
- mimics carotid artery aneurysm and requires angiography or MRA
What are the clinical signs of hemiplegic migraine?
- sudden hemiparesis, hemiplegia, aphasia, or confusions
- less than an hour
- mimics transient ischemic attack (TIA)
- familial incidence 98%
What are the clinical symptoms of Basilar Artery Migraine?
- vertigo, tinnitus, visual blurring, dysarthria, ataxia, syncope, stupor, bilateral or unilateral paresthesias
- mimics Wallenburg Syndrome
- common in women under 21
What is required if the patient has Basilar Artery Migraine?
work-up for vertebral basilar arterial insufficiency (MRA)
When should prophylactic pharmaceuticals be given?
more than two headaches per month
