Flashcards in Headaches and Migraines Deck (65)
List the red flags that could indicate something more severe.
New onset headaches >35
History or present malignancy
Early morning headache
Worsened by valsalva manoeuvre
Describe the frequency of migraines without an aura.
At least 5 attacks with a duration of 4-72 hours
Describe migraine without an aura?
Moderate to severe unilateral throbbing which is worse on movement.
Can be accompanied by photophobia or phonophobia
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
What is an aura?
A fully reversible sensory motor or language symptom
How long do auras related to a migraine last?
Do auras usually precede or follow a migraine?
Usually occur one hour prior to migraine onset.
Describe some common visual auras?
Central scotoma - central fuzziness
What regions of the brain are linked to migraines?
Dorsal raphe nucleus
What chemicals have been linked to triggering a migraine?
What system when activated is thought to trigger a migraine with aura?
Trigeminal Vascular system
List some causes of migraines with aura?
What are some non pharmacological treatments for migraines?
Education on triggers e.g. diet sleep relaxation etc
What are some pharmacological treatments for migraines once they have started?
NSAIDs Aspirin Naproxene Ibuprofen
What are Triptans?
5HT seretonin agonists
How are triptans administered and when?
Orally, Sublingually or subcutaneously
Start of the headache for sustained relief
In order to be put on migraine prophylaxis what must the patient present with?
More than three attacks per month
Very severe migraines
What is the rule in terms of pharmacological treatment of migraines?
Start low go slow
What tricyclic can be used for migraine prophylaxis?
What are some common side effects of amitriptyline?
What is first line in migraine prophylaxis?
What are some common side effects of propanolol?
Avoid in asthma
Peripheral vascular disease
If beta blockers are unsuitable what can be given for migraine prophylaxis ?
What is Topiramate?
Carbonic anhydrase inhibitor
What are some of the side effects with Topiramate?
AVOID if looking to conceive
List some other drugs which can be used for migraine prophylaxis?
How long should prophylaxis be used for before determining whether or not it is effective?
3 months at maximum dosage
What lifestyles factors should be altered in someone complaining of chronic migraines?
Increase water to >2L
What class of drug should be taken alongside the acute migraine treatment?
Anti emetic - Metoclopramide Hydroxychloride