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Year Two - Neurology System > Migraines > Flashcards

Migraines Flashcards

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1
Q

What are migraines?

A

They are defined as a chronic disorder in which patients experience episodic attacks of a headache and other associated clinical features

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2
Q

What is the pathophysiology of migraines?

A

There is no simple explanation for why migraines occur, and it may be a combination of structural, functional, chemical, vascular and inflammatory factors

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3
Q

What are the four classifications of migraines?

A

Migraines Without Aura

Migraines With Aura

Silent Migraines

Hemiplegic Migraines

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4
Q

What are migraines without aura?

A

They are defined as migraines which occurs without specific warning signs just before the headache begins

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5
Q

What are migraines with aura?

A

They are defined as migraines which occurs with specific warning signs just before the headache begins

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6
Q

What are silent migraines?

A

They are defined as migraines that result in aura clinical features; however, no headache is experienced

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7
Q

What are hemiplegic migraines?

A

They are a rare type of migraine in which individuals experience a temporary weakness on one side of their body (hemiplegia) as part of their migraine attack

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8
Q

What do hemiplegic migraines mimic? What do we do as a result?

A

Strokes

It is important to act fast and thoroughly investigate these patients

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9
Q

What are the ten migraine triggers?

A

Chocolate

Hormonal Changes

Orgasms

Cheese/Caffeine

combined Oral contraceptives

Lights

Alcohol

Tiredness

Exercise

Stress

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10
Q

Which gender is at a greater risk of migraines?

A

Females

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11
Q

What should we consider when female patients present with migraines?

A

We should look at their medication list and check whether they are being prescribed the combined oral contraceptive pill

This should then be changed to a progesterone only or non-hormonal contraceptive method

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12
Q

What is an absolute contraindication of the COCP?

A

Migraines with aura

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13
Q

Why is the combined oral contraceptive pill contraindicated in migraine with aura?

A

There is an increased risk of ischaemic stroke

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14
Q

What are the five clinical features of migraines?

A

Severe Unilateral Throbbing Headache

Headache Worsening Due To Exercise

Photophobia

Phonophobia

Nausea & Vomiting

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15
Q

What is photophobia?

A

It is defined as a sensitivity to light

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16
Q

What is phonophobia?

A

It is defined as a sensitivity to sound

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17
Q

How long do migraine attacks usually last?

A

4 – 72 hours

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18
Q

What is a prodrome?

A

It refers to subtle changes that warn of an upcoming migraine, usually occurring three days before the headache

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19
Q

What are the six clinical features of a predrome?

A

Constipation

Urinary Frequency

Neck Stiffness

Mood Changes

Food Cravings

Yawning

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20
Q

What is a migraine aura?

A

It refers to transient neurological symptoms which may occur hours before or during an attack

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21
Q

What are the six clinical features of a migraine aura?

A

Blurry Vision

Hemianopia Disturbances

Spreading Scintillating Scotoma

Paraesthesia

Ataxia

Dysarthria

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22
Q

What is hemianopia?

A

It is defined as vision loss affection half the visual field

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23
Q

What is scotoma?

A

It is defined as a spot in the visual field in which vision is absent or deficient

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24
Q

What is ataxia?

A

It is defined as a group of symptoms including slurred speech, stumbling, falling and incoordination

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25
What is dysarthria?
It is a motor speech disorder in which the muscles that are used to produced are damaged, paralysed or weakened
26
How long do the clinical features of a migraine aura tend to last?
15 - 60 minutes
27
What do migraine auras commonly get mistaken for?
A transient ischaemic attack (TIA) This is due to the fact that it similarly causes a sudden loss of function
28
Which five aura features are deemed as atypical, requiring further investigation/referral?
Motor weakness Double vision Unilateral visual disutrbances Poor balance Decreased level of consciousness
29
What is a post-drone?
It is a phase that can occur after a migraine attack
30
What are the three clinical features of a pro-drome?
Fatigue Confusion Elation
31
What investigations can be conducted to diagnose a migraine?
There are no specific investigations that can be conducted However, a diagnosis can be aided by the conduction of a migraine diary
32
How long should we advise individuals to keep note of a migraine diary for?
A few weeks
33
What information should be noted in a migraine diary?
Date Time Duration of attack Clinical features experienced Medications administered
34
How are migraine diaries used to diagnose/investigate migraines?
They allow recognition of overuse headaches, which are caused by administration of painkillers on a long-term basis It also allows identification of potential triggers for an individual’s migraine, which can allow individuals to take prophylactic measures
35
What would indicate that individuals have a medication overuse migraine?
If they take painkillers on more than 10 days every month and experience migraine features
36
What feature would provide a definitive diagnosis of migraine medication overuse headaches?
The clinicla features resolve, or revert to their original pattern, within 2 months of stopping the medication
37
What is the migraine diagnostic criteria from 'The International Headache Society'?
There should be at least five migraine attacks, which fulfil the following criteria... - Headache duration 4 -72 hours - Headache needs to meet two of the following criteria (unilateral, pulsating quality, moderate to severe intensity, aggravated by exercise) - During headache there is either nausea and vomiting OR photophobia and photophobia - The headache is not attributed to another disorder
38
In what way do we conservatively manage a migraine attack?
This involves advising patients to go into a quiet, dark room to sleep In some cases, individuals feel better once they have vomited
39
In what three ways do we pharmacologically manage migraine attacks?
Basic Analgesia Triptans Antiemetics
40
What four basic analgesia drugs can be used to manage migraine attacks?
Paracetamol Ibuprofen Naproxen Aspirin
41
When should patients take basic analgesia drugs when managing migraine attacks? Why?
It is advised that individuals take these at the first signs of a migraine attack This gives them time to absorb into the bloodstream and ease symptoms
42
What basic analgesia is not advised for patients to take during a migraine attack?
Co-codamol
43
What drug classification do triptans belong to?
5HT receptor (serotonin receptor) agonists
44
What two triptans can be administered to manage a migraine attack?
Sumatriptan Rizatriptan
45
What are the three mechanisms of actions of triptans?
Vasoconstriction of arteries Inhibition of peripheral pain receptors Reduced neuronal activity in the CNS
46
Which administration route of triptans is recommended in adults?
Oral
47
Which administration route of triptans is recommended in patients aged 12 - 17?
Intranasal
48
What is a side effect of triptans?
Chest tightness
49
What are the two contraindications of triptan administration?
Cardiovascular Disease SSRIs
50
What three anti-emetics are used to manage migraines attacks?
Chlorpromazine Metoclopramide Prochlorperazine
51
What is the first line anti-emetic used to manage migraines?
Metoclopramide
52
When are anti-emetics used to manage migraine attacks?
If the patient’s migraine with aura is accompanied by nausea and vomiting
53
What is a side effect of metoclopramide, in young patients?
Acute dystonia reaction
54
What are the three acute pharmacological management options that can be used to manage predictable menstrual migraines?
Mefanamic acid OR A combination of aspirin, paracetamol and caffeine OR Triptans
55
How do we prevent the development of medication overuse migraines when pharmacologically managing them?
We limit the prescription of these drugs to ten per month, which is equivalent to two per week
56
In cases where medication overuse migraines develop, what is the most appropriate management?
We stop simple analgesia and triptans abruptly We withdraw opioid analgesia gradually
57
When is prophylactic management of migraines recommended?
> 2 attacks/month
58
In what two ways do we conservatively prevent migraines?
We can advise patients about acupuncture therapy. This is usually not conducted by the GP practice and patients would have to explore this privately. It is suggested that individuals trial a course of up to 10 sessions over a 5-8 week period. We can ask patients to complete a migraine diary to allow identification of potential triggers for an individual’s migraine. This can allow individuals to take prophylactic measures to avoid these triggers.
59
When is acupuncture recommended to prophylactically manage migraines?
Third line management option Following hypertensive and anti-convulsant failure
60
In what four ways can we pharmacologically prevent migraines?
Hypertensives Anti-Convulsants Tricyclic Antidepressants Botulin A Injections
61
When do we administer hypertensives to prevent migraines?
They are the first line prophylactic medications advised
62
What three hypertensives are used to prevent migraines?
Propranolol Metoprolol Verapamil
63
When do we administer anti-convulsants to prevent migraines?
They are the second line prophylactic medications advised
64
What anti-convulsant do we use to prevent migraines?
Topiramate
65
What should we remember when we administer topiramate?
It is a teratogenic drug and therefore it should not be administered to pregnant patients and those of child bearing age
66
What are the two teratogenic effects of topiramate?
Cleft lip Cleft palate
67
When are tricyclic antidepressants used to prevent migraines?
They are the third line prophylactic medications advised
68
What tricyclic antidepressant is used to prevent migraines?
Amitriptyline
69
When should we administer botulin A injections to prevent migraines?
They should be considered in individuals who suffer from chronic migraines and as a last resort
70
How often should botulin A injections be administered to prevent migraines?
Every 12 weeks
71
What are the two prophylactic pharmacological management options that can be used to manage predictable menstrual migraines? What doses?
Frovatriptan (2.5 mg twice a day) OR Zolmitriptan (2.5 mg twice or three times a day)
72
How should we generally manage pregnant/breastfeeding patients with migraines?
Pharmacological migraine treatment should be limited as much as possible in these patients Instead, these patients should identify and avoid potential migraine triggers
73
When pharmacological management is essential, what is the first line pharmacological management option in pregnant/breastfeeding patients with migraines?
Paracetamol 1g
74
When pharmacological management is essential, what is the second line pharmacological management option in pregnant/breastfeeding patients with migraines? In which two trimesters can this be administered in?
NSAIDs First & second
75
Which two opioids should be avoided during pregnancy to manage migraines?
Aspirin Codeine
76
Is HRT safe to administer in a patient with a history of migraine?
Yes, however it can make the migraines worse

Year Two - Neurology System (25 decks)

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