Migraine

Question 1

Migraine: General

Answer 1

• Trigeminal Vascular System Disorder
• F>M (3:1)
• Onset: 1st decade
• Family History

Question 2

Migraine: Classification

Answer 2

• 1.1 Migraine w/o Aura
• 1.2 Migraine w/Aura
• 1.3 Chronic Migraine
• 1.4 Migraine Complications
• 1.5 Probable Migraine
• 1.6 Episodic Syndromes that may be associated w/migraine

Question 3

1.4: Migraine Complications: Subtypes

Answer 3

• 1.4.1 Status Migrainous
• 1.4.2 Persistent aura w/o infarction
• 1.4.3 Migrainous Infarction
• 1.4.4 Migraine aura-triggered seizure

Question 4

1.6: Episodic syndromes that may be associated w/Migraine: SUBTYPES

Answer 4

• 1.6.1 Recurrent GI Disturbance
• 1.6.1.1 Cyclical Vomiting Syndrome
• 1.6.1.2 Abdominal migraine
• 1.6.2 Benign Paraxyimal vertigo
• 1.6.3 Benign Paraxyimal torticollis

Question 5

1.1: Migraine w/o aura (MWA)

Answer 5

• Young (<20 y.o.)
• Location: Unilateral HA
  Side-locked migraine
  ocular, temporal, frontal regions
• Quality: Throbbing or pulsating
  Moderate -severe intensity
  Periodic HA: lasts 4-72 hrs; Longer=Stratus Migranous)
• <1 MA/month
• Associated Signs:
  Vomit during attack
  Nausea
  Photo or Phonophobia

Question 6

1.2: Migraine w/Aura (MA)

Answer 6

• Recurrent Disorder
• reversible focal neuro symptoms
  develops over 5-20 mins; lasts < 60 mins
  followed by Headache
• Aura=visual, sensory, speech symptoms
• Visual Aura:
  flickering, uncolored, zigzag line in center of visual field
  affects central veision
• Sensory Disturbance
  Pins & Needles
  Unilateral
  starts in hand-> arm->face-> tongue
• Speech
  dypashic
• Motor
  half sides
  affects hand and arm

Question 7

1.3: Chronic Migraine (CM)

Answer 7

• HA> 15 days/mo for > 3 months; w/no medication overuse
  starts as episodic migraine -> chronic
• Location: Bilateral
  frontotemporal region
• Quality: dull and pressing
  Mild to moderate
• Associated Symptoms: Decreased intensity
  Nausea
  Photophobia
• Women=Night-time arousal/ early morning HA

Question 8

Migraine: Comorbidity

Answer 8

• Strong Evidence
  Depression
  Anxiety
  Stroke (w/smoking)
• Less Evidence
  asthma
  CVD (Mitral valve prolapse)
  GI disorders
  epilepsy

Question 9

Migraine: Phases

Answer 9

1. Premonitory Phase (60%)
2. Aura (20%)
3. Headache
4. Postdrome

Question 10

Premonitory Phase: Symptoms

Answer 10

• Keep Headache diary
• Prodrome=early signs
  Bells Orofacial Pains
• Psychologic
  Depression
  Hyperactivity
  Euphoria
  Talkative
• Neurologic
  Photophobia/Phonophobia
  Difficulty concentrating
  Dysphagia
• General
  Stiff neck
  Food cravings
  Cold Feeling
  Anorexia

Question 11

Aura Phase:

Answer 11

• Slow propagating wave of depolarization, hyperpolarization, and vascular changes
• Sensory:
  Paresthesia
• Motor:
  Focal fatigue
  difficulty w/speech-Hemiplegic migraine
• 99% report visual symptoms

Question 12

Headache Phase

Answer 12

• HA attacks last: 4-72 hrs
• at least 2 of:
  Unilateral
  Pulsating (throbbing)
  Moderate-severe pain
  Aggravation by Physical activity
• at least 1 of:
  N &/or V
  Photophobia & Phonophobia

Question 13

Postdrome Phase

Answer 13

• Fatigue
• Mood Changes (irritability)
• Can’t Concentrate
• Muscle weakness/ache
• Loss of appetite