Migraine Flashcards
Pathophysiology
Severe headaches, usually episodes but can be chronic
Triggers - mneumonic
CHOCOLATES
(Ch)geese (O)ral contraception (C)caffeine or its withdrawal Alcoh(ol) (A)nxiety (T)ravel (E)exercise (S)leep deprivation
S+S - mneumonic
POUNDing headache
(P)hoto or phonophobia Lasts 4-72 h(o)urs (U)nilateral - however can be bilateral (N)ausea and vomiting (D)ebilitating - patient will want to be still
25% experience aura
How long before headache?
Types of aura:
- Visual - 1
- Sensory - 2
- Motor - 4 - speech, coordination, eyes, limbs
Other symptoms in aura
15-30 minutes pre +/- during headache
Sparkles, flashing lights, scotoma (partial loss of visual fields)
Numbness and tingling
Dysarthria
Ataxia
Ophthalmoplegia
Hemiparesis
Dysphasia
ANS symptoms - lacrimation, conjunctival injection
What do some people experience on its own?
What long can a prodrome take and what sort of symptoms do you get?
Aura
Hours to days
Sleepy, moody or hungry
Risk factors:
Male/female
Birth control
Weight
Congenital defect
Asked in most histories
Female - often premenstrual
Combined contraceptive pill
Obesity
PFO - shunting of blood through the PFO causes microinfarcts in the brain, leading to irritation and a tendency for migraine
FH
Diagnosis
What is the criteria?
≥2 headaches with aura.
Or
≥5 headaches lasting 4-72 hours
AND any 1 of {nausea/vomiting or phono/photophobia}
AND any 2 of {unilateral location, pulsating quality, moderate or severe intensity, worse on moving, or limiting activity}.
Home treatment
Pain meds
1 migraine drug - starts with t
What med starting with m might be added? - it is a pro kinetic agent - speeding the movement of food through the stomach and intestines but used in migraines
NSAID or paracetamol
Triptan
Metoclopamide
Home treatment:
Non-oral options if vomiting:
How is triptan given - 2
How is diclofenac and domperidone given - 1
What can they do to relieve their symptoms?
SC/IN (intranasally)
PR (per rectal)
Lie down in a dark room
Emergency department treatment of severe migraines:
Paraenteral options - 2
What can be given to prevent recurrence within 72 hrs
Triptan SC
Antiemetic IV
Dexamethasone IV - reduce headache recurrence within 72 hrs
Prevention
Avoid triggers - how can they be managed
Indications for medical prophylaxis:
-how many episodes per month
Regular meals
Good sleep
Avoid dehydration
Stress reduction - CBT, relaxation therapy
Frequent disability >2 episodes in a month
Standard acute treatment not effective
Prevention
1st line - 1 beta blockers, 1 calcium channel blockers and 1 is anticonvulsant
What is best for children?
What can be given for hemiplegic migraine? - it is a CCB
Propranolol
Amitriptyline
Topiramate
Propranolol
Verapamil
Complications - just read
What drug that is specifically for females is contraindicated in migraine?
Chronic migraine - debilitating Status migrainous - >72 hrs migraine Migrainous infarct Depression Anxiety
COCP - For women who suffer from migraines with aura, taking combined oral contraceptives heightens their stroke risk even more. It’s specifically the hormone estrogen in the oral contraceptive that can cause a stroke.
Triptans:
Examples - just read
MOA
Sumatriptan
Almotriptan
Eletriptan
Rizatriptan
Vasoconstrictor
Triptans:
Contraindications - think of problem of causing vasoconstriction
Drug interactions:
- one is antipsychotic drug used to treat bipolar and depression?
- one is an antidepressant?
CVD - IHD, HTN, coronary spasm
Lithium
SSRI’s
