Headaches and Migraines Flashcards Preview

Neurology Year 3 > Headaches and Migraines > Flashcards

Flashcards in Headaches and Migraines Deck (65)
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1

List the red flags that could indicate something more severe.

New onset headaches >35
History or present malignancy
Immunosuppression
Early morning headache
Worsened by valsalva manoeuvre

2

Describe the frequency of migraines without an aura.

At least 5 attacks with a duration of 4-72 hours

3

Describe migraine without an aura?

Moderate to severe unilateral throbbing which is worse on movement.
Can be accompanied by photophobia or phonophobia

4

What is the pathophysiology of migraines?

Both vascular and nueronal causes
Stress causes seretonin release
Blood vessels constrict or dilate
Substance P is released which irritates vessels and nerves causing pain

5

What is an aura?

A fully reversible sensory motor or language symptom

6

How long do auras related to a migraine last?

20-60 mins

7

Do auras usually precede or follow a migraine?

Usually occur one hour prior to migraine onset.

8

Describe some common visual auras?

Central scotoma - central fuzziness
Hemianopia loss

9

What regions of the brain are linked to migraines?

Dorsal raphe nucleus
Locus Coeruleus

10

What chemicals have been linked to triggering a migraine?

Substance P
Neurokinin A
CGRP

11

What system when activated is thought to trigger a migraine with aura?

Trigeminal Vascular system

12

List some causes of migraines with aura?

Sleep deprivation
Diet
Stress
Hormones
Physical exertion

13

What are some non pharmacological treatments for migraines?

Prevention
Education on triggers e.g. diet sleep relaxation etc

14

What are some pharmacological treatments for migraines once they have started?

NSAIDs Aspirin Naproxene Ibuprofen
Triptans- Fovatriptan

15

What are Triptans?

5HT seretonin agonists

16

How are triptans administered and when?

Orally, Sublingually or subcutaneously
Start of the headache for sustained relief

17

In order to be put on migraine prophylaxis what must the patient present with?

More than three attacks per month
Very severe migraines

18

What is the rule in terms of pharmacological treatment of migraines?

Start low go slow

19

What tricyclic can be used for migraine prophylaxis?

Amitriptyline 10-25mg

20

What are some common side effects of amitriptyline?

Dry mouth
Postural hypertension

21

What is first line in migraine prophylaxis?

Propanolol 80mg

22

What are some common side effects of propanolol?

Avoid in asthma
Peripheral vascular disease

23

If beta blockers are unsuitable what can be given for migraine prophylaxis ?

Topiramate 25-100mg

24

What is Topiramate?

Carbonic anhydrase inhibitor

25

What are some of the side effects with Topiramate?

AVOID if looking to conceive
Weight loss
Paraesthesia
Impaired concentration

26

List some other drugs which can be used for migraine prophylaxis?

Gabapentin
Sodium Valproate
Botulinum Toxin

27

How long should prophylaxis be used for before determining whether or not it is effective?

3 months at maximum dosage

28

What lifestyles factors should be altered in someone complaining of chronic migraines?

Healthy diet
Increase water to >2L
Reduce caffeine
Regular exercise
Reduce stress

29

What class of drug should be taken alongside the acute migraine treatment?

Anti emetic - Metoclopramide Hydroxychloride

30

What is a Acephalgic Migraine?

Aura without the headache/migraine