migraine lokin ver

Question 1

migraine epidemiology

Answer 1

12% of popu

adolescence - 90% of first attacks before 40

female 30-39

75% - migraine s aura

Question 2

discuss pathophysio of migraine (cortical spreading depression)

Answer 2

neuronal dysfunction with secondary vascular changes

aura d/t cortical spreading depression; bimodal pattern

excitation or hyperex - inc BF - dec neuronal firing and BF - spreads across cortex

scintillations or tingling - scotoma or numbness - activation of CN V - inflammation - pain in meninges - trigeminovascular system

activation of trigeminovascular complex - calcitonin and substance P = neurogenic inflamm

Question 3

discuss pathophysio of migraine (trigeminovascular complex)

Answer 3

activation of trigeminovascular complex - calcitonin and substance P = neurogenic inflamm - vasodilation and protein - sensitizations

sensitization - dec in nociceptive and non stim thresholds - sponty neuro activity - migraine

Question 4

what is CGRP

Answer 4

Calcitonin Gene Related Peptide - neurotransmitter related to migraine

Question 5

components of trigeminovascular complex

Answer 5

trigeminal nucleus, caudalis, ventral posteromedial nucleus of the thalamus, and sensory cortex.

Question 6

discuss prodrome

Answer 6

hours to days prior to HA

physio sx - irritability, mood change, drowsy, euphoria

gen nonspecific sx - food craving, anorexia, bowel changes, neck tightness

neuro sx - concentration diff, photophobia, phonophobia, osmophobia

Question 7

discuss aura

Answer 7

25% of the people with migraine - occur before HA

gradual dev
< 1 hr
+ and - sx
complete reversibility

may be confused for stroke or TIA

Question 8

aura occurs but no HA

Answer 8

acephalgic migraine

Question 9

what is visual aura

Answer 9

small area of visual loss or appearing as a bright spot

5 min - 1 hr: quadrant or hemifield

geometric shapes or zigzag lines over edges

shimmering or scintillating quality in periphery

vision starts to return when may vision loss

Question 10

what is somatosensory aura

Answer 10

uni tingling then numbness as it migrates

may move inside mouth - buccal mucosa and half the tongue

Question 11

what is language aura

Answer 11

transient language problems - word finding difficulty

Question 12

what is motor aura

Answer 12

hemiplegic migraine - more than an hour (and then return back to normal)

Question 13

discuss postdromal phase

Answer 13

sudden head movement or valsalva may trigger pain

concentration diff and fatigue

irritability, euphoria, anorexia, feeling of weakness

Question 14

requirements for migraine s aura

Answer 14

at least 5 attacks c:

• lasts 4 hrs to 3 days
• at least 2 of: uni, pulsating, mod to severe, aggrav of activity or avoidance
• at least 1: nausea, vomiting, photo or phono phobia
• (-) ICHD 3 diagnosis

Question 15

requirements for migraine c aura

Answer 15

at least 2 attacks c:

• lasts 4 hrs to 3 days
• one or more fully reversible aura
• at least 3 of: spreads > 5 mins, 2 or more sx, uni, aura, end of aura followd by HA in 60 mins
• (-) ICHD 3 diagnosis

Question 16

what is migraine c brainstem aura

Answer 16

basilar-type migraine

brainstem sx s weakness

auras can be: Vertigo (light headedness), Dysarthria, Tinnitus, Diplopia, Ataxia, Decreased sensorium, Hyperacusis

Question 17

discuss hemiplegic migraine

Answer 17

motor weakness as aura - uni; mistaken as stroke

> 1 hr

genetically linked

Question 18

discuss retinal migraine

Answer 18

ocular migraine - monocular scotoma blindness lasting less than an hour; irreversible vision loss

Question 19

discuss ophthalmoplegic migraine

Answer 19

painful ophthalmoplegic neuropathy

HA c weakness of one or more oculumotor nerves; CN3

Question 20

discuss migrainous vertifo

Answer 20

episodic vertigo and other features of migraine; exam normal when symptomatic