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A. Block D Neurology > Migraines > Flashcards

Migraines Flashcards

1
Q

Primary headaches = no known cause
Secondary headaches = have a known cause

Which of these is more common?

A
  • primary
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2
Q

What is the most common type of primary headache?

1 - migraines
2 - thunderclap
3 - tension type
4 - cluster

A

3 - tension type
- migraine is the 2nd most common form of primary headache

  • incidence of 0.5-5%
  • difficult to identify exact incidence
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3
Q

What is the most common debilitating headache?

1 - tension headache
2 - thunderclap headache
3 - Migraine
4 - Cluster headaches

A

3 - Migraine
- also 2nd most common type of primary headaches

  • 7th highest cause disability globally
  • 2.9% of years of life lost to disability
  • twice as likely in women
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4
Q

Can migraines be pulsatile in nature?

A
  • yes

Pulsatile may suggest increases BP or increased intracranial pressure

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5
Q

What is the incidence of migraines?

1 - 50/100,000
2 - 500/100,000
3 - 5000/100,000
4 - 50,000/100,000

A

3 - 5000/100,000

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6
Q

At what time do migraines generally start and begin to decline?

1 - starts at puberty and declines around 20y/o
2 - starts at puberty and declines around 40y/o
3 - starts at puberty and declines around 60y/o
4 - starts at puberty and declines around 80y/o

A

2 - starts at puberty and declines around 40y/o

  • 2% have chronic migraines, causing medication overuse
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7
Q

Are migraines more common in men or women?

A
  • women
  • 3x more likely
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8
Q

Menstrual migraines can occur in women. When would these generally occur?

1 - days 1-2
2 - days 2-3
3 - days 5-7

A

2 - days 2-3
- before the period of during the period

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9
Q

Are patients with comorbid psychiatric disorders such as anxiety & depression more or less likely to experience medication overuse headaches?

A
  • more likely
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10
Q

The trigeminal nerve (CN5) is derived from the 1st pharyngeal arch and is the largest of all the cranial nerves. What functions does this cranial nerve have?

1 - sensory only of the face
2 - motor only of mastication muscles
3 - both of the above
4 - none of the above

A

3 - both of the above

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11
Q

What is the trigeminocervico complex?

1 - CN V (5) meets cervical vertebrae 1
2 - CN V (5) synapses in same nucleus as cervical vertebrae 1
3 - CN V (5) synapses in same nucleus as cervical vertebrae 1 and 2
4 - CN V (5) synapses in same nucleus as cervical vertebrae 1-3

A

4 - CN V (5) synapses in same nucleus as cervical vertebrae 1-3

  • sensory only from CV V (5)
  • this essentially means any sensory information from cervical vertebrae 1-3 can revert pain to the head causing a headache
  • region of the brain receives nociceptive stimulus
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12
Q

The trigeminocervico complex is a nucleus where CN V (5) synapses in same nucleus as cervical vertebrae 1-3 for sensory receptors only. Where is this located?

1 - cerebellum
2 - brain stem
3 - pons
4 - medulla oblongata and upper cervical spine

A

4 - medulla oblongata and upper cervical spine

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13
Q

Which of the following is not part of the trigeminal nerve?

1 - ophthalmic
2 - maxillary
3 - accessory
4 - mandibular

A

3 - accessory

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14
Q

The spinal trigeminal nucleus is a nucleus in the medulla that receives information about deep/crude touch, pain, and temperature from the ipsilateral (same side) face. Which of the following is important for pain and temperature sensations?

1 - Pars oralis
2 - Pars interpolaris
3 - Pars caudalis

A

3 - Pars caudalis

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15
Q

Which of the following are typical triggers for developing a migraine?

1 - tiredness, stress, dehydration
2 - alcohol
3 - combined oral contraceptive pill
4 - cheese, chocolate, red wines, citrus fruits
5 - menstruation
6 - bright lights
7 - all of the above

A

7 - all of the above
Remember the mnemonic CHOCOLATE:

C = chocolate
H = hangovers
O = orgasms
C = cheese/caffeine
O = oral contraceptive
L = lie-ins
A = alcohol
T = travel
E = exercise

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16
Q

Migraines are a form of primary headaches, which essentially means the cause is unknown. Do migraines typically present unilaterally or bilaterally?

A
  • unilaterally
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17
Q

Which of the following locations would the main symptom of a migraine be felt?

1 - on one side of the face
2 - around the eye on one side of the face
3 - across the top of the forehead
4 - all of the above

A

1 - on one side of the face

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18
Q

Migraines are a form of primary headaches, which essentially means the cause is unknown. Which of the following do migraines NOT typically present with?

1 - severe, bilateral, throbbing headache
2 - nausea, photophobia (sensitive to light) and phonophobia (fear of sound)
3 - can last up to 72h
4 - patients typically stay in dark and quiet rooms
5 - auras maybe present
6 - stiff neck
7 - vary 1-2/month or 1/year

A

1 - chronic, bilateral, throbbing headache

  • typically migraines are unilateral
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19
Q

A migraine aura is something that you experience when having a migraine. which of the following is true?

1 - can be visual only
2 - can be auditory only
3 - can be motor or sensory
4 - all of the above

A

4 - all of the above

  • most common is visual, and it is completely reversible
  • builds up over time and can last up to 60 minutes
  • more common in older patients, but no headaches
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20
Q

An aura is when there are visual changes that are associated with migraines. What visual symptoms can be experienced in an aura?

1 - Sparks in vision
2 - Blurring vision
3 - Lines across vision
4 - Loss of different visual fields
5 - all of the above

A

5 - all of the above

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21
Q

Auras typically occur prior to a migraine and can include visual (most common), auditory, motor and sensory aspects. Typically how long can the auras last for?

1 - <10 minutes
2 - <40 minutes
3 - <60 minutes
4 - <2 hours

A

3 - <60 minutes

22
Q

How long do migraines typically last?

1 - 4-72 hours
2 - 15-180 minutes
3 - 30 minutes to 1 week
4 - >1week

A

1 - 4-72 hours

23
Q

When migraines are present are they continuous or episodic?

A
  • episodic
  • typically throbbing unilaterally, but can be bilateral
  • feels like someone is drilling on the side of your head
24
Q

Is the pain experienced during a migraine typically severe or moderate?

A
  • Can range from moderate to severe
25
Q

Overuse of medication can present in a similar way to migraines. Which of the following are present in migraines that helps distinguish migraines from medication overuse in headaches?

1 - occurrence of headache
2 - duration of the migraine
3 - nausea and vomiting
4 - gender

A

3 - nausea and vomiting
- both are present in migraines

26
Q

When performing a history on a patient with a headache, if there is an increase in headache symptoms when performing a Valsalva manoeuvre bad?

A
  • Yes

Indicates a space occupying lesion in cranial cavity

Causes an increased intracranial pressure

27
Q

When performing a history on a patient with a headache, which of the following is NOT typically a red flag?

1 - patient wakes up with headache
2 - change in character
3 - age of onset
4 - sudden onset (thunderclap)
5 - focal neurological deficits
6 - constitutional symptoms (fever, meningism, rash, weight loss)

A

1 - patient wakes up with headache

A RED FLAG here would be if the headache wakes the patient whilst they are asleep

28
Q

When examining a patient, all of the following are RED FLAGS except which one?

1 - patient appears sick-appearing, skin changes
2 - evidence of trauma
3 - altered cognitive state
4 - ocular: hyphema, pupil non-reactivity, optic disc swelling, proptosis, restricted eye movements
5 - meningism
6 - weight gain
7 - focal neurological findings (eg limb weakness)

A

6 - weight gain

Weight loss is a red flag as it could be caused by malignancy

29
Q

Of the following, which is most likely to trigger a migraine?

1 - dehydration and stress
2 - food and weather
3 - cigarettes and alcohol
4 - medications

A

2 - food and weather

30
Q

When diagnosing a migraine if the patient has no aura, how many migraines lasting 4-72h should a patient have had?

1 - >3
2 - >5
3 - >8
4 - >12

A

2 - >5

31
Q

When diagnosing a migraine if the patient has no aura, patients should have >5 migraines lasting 4-72h with nausea or vomiting. They should also have how many of the following?

  • unilateral pain
  • pulsing pain
  • impairs ADL
  • photophobia/phonophobia

1 - >2
2 - >3
3 - all 4

A

1 - >2

32
Q

In addition to aura, which of the following occurring would suggest that the patient is having a migraine over tension headaches and cluster headaches?

1 - ipsilateral (same side) autonomic features
2 - no features at all (including aura)
3 - aura, vomiting and nausea
4 - none of the above

A

3 - aura, vomiting and nausea

33
Q

Following a migraine, which of the following symptoms are unlikely to occur?

1 - fatigue
2 - tired
3 - lacrimation and ptosis
4 - difficulty concentrating
5 - stiff neck

A

3 - lacrimation and ptosis
- this commonly occurs in cluster headaches

34
Q

What is typically the 1st line treatment patients with migraines are given as part of abortive approach?

1 - paracetamol
2 - lifestyle advice
3 - NSAIDs
4 - Triptan (serotonin agonist)

A

2 - lifestyle advice
- adequate sleep, hydration, exercise, cognitive behavioural therapy, biofeedback and avoiding triggers

Patients may also be asked to complete a migraine diary

35
Q

If lifestyle advice fails in patients with migraines, which of the following can then be prescribed next as part of abortive approach?

1 - paracetamol
2 - aspirin
3 - NSAIDs
4 - Triptan (serotonin agonist)

A

1 - paracetamol
- then it would be aspirin and NSAIDs
- if these fail then we can use:

+ Triptan (eg sumatriptan, zolmitriptan)
+ Dopamine agonists (metoclopramide, prochlorperazine)
+ Monoclonal antibodies
+ Nerve block injections

36
Q

Which of the following can be prescribed as a one off dose for migraines?

1 - gabapentin
2 - tramadol
3 - sumatriptan
4 - prochlorperazine

A

3 - sumatriptan

Dose of 50-100mg

<6/day and prescribe no more than 6/month

37
Q

Should opioids ever be prescribed for the acute management of patients with migraines?

A
  • no
38
Q

What is typically the 1st line treatment patients with migraines are given as part of a preventative approach?

1 - Amitriptyline
2 - Lifestyle advice
3 - Propranolol
4 - Topiramate

A

2 - Lifestyle advice

39
Q

If lifestyle advice fails in patients with migraines, all of the following can be prescribed, EXCEPT which one?

1 - Amitriptyline
2 - Morphine sulphate
3 - Beta blockers
4 - Topiramate

A

2 - Morphine sulphate
Never use opioids in migraines

Topiramate = GABA agonist and AMPA antagonist

Block neuronal excitability that is causing migraines

40
Q

Which of the following would be a suitable differential for a patient with suspected migraine?

1 - cluster/tension headache
2 - cervical spondylosis
3 - intracranial pathology
4 - increased BP
5 - TIAs
6 - sinusitis/otitis media
7 - all of the above

A

7 - all of the above

41
Q

Patients who are menstruating may experience a menstruating migraine. Typically this last 2-3 days of the menstrual cycle, and occurs in 2/3 of cycles. Which 2 of the following medications can be used to prevent menstruating migraines?

1 - fovatriptan (inhibit cranial vasodilation)
2 - zolmitriptan (serotonin receptor agonist and inhibit vasodilation)
3 - verapamil (induces vascular vasodilation)
4 - B-blockers (slows heart rate and reduces brain oxygen requirements)

A

1 - fovatriptan (inhibit cranial vasodilation)
2 - zolmitriptan (serotonin receptor agonist and inhibit vasodilation)

42
Q

Is it ok to prescribe the combined oral contraceptive (COC) pill in women who are experiencing migraines with aura?

A
  • No

This is a 4 on the Mec guidelines

COC can increase the risk of stroke

43
Q

Medication-overuse headache are caused by taking painkillers too often for tension headaches . The body responds to this by increasing the number of pain receptors in the head. Which of the following is NOT typically linked to causing medication overuse headaches?

1 - codeine
2 - cyclizine
3 - triptans
4 - NSAIDs

A

2 - cyclizine

All others are pain medications, except triptan which is specific for headaches

44
Q

Migraines = feature full headaches

Tension like headaches = featureless headaches

A

This essentially means there are specific features associated with Migraines (aura, vomiting, photophobia etc..

45
Q

When thinking about red flags, which of the following is most likely to cause a new severe or unexpected headache?

1 - malignancy
2 - sub-arachnoid haemorrhage
3 - subdural bleed
4 - giant cell arteritis

A

2 - sub-arachnoid haemorrhage

Also described as a thunderclap headache

46
Q

When thinking about red flags, which of the following is most likely to follow a head trauma?

1 - malignancy
2 - sub-arachnoid haemorrhage
3 - subdural bleed
4 - giant cell arteritis

A

3 - subdural bleed

47
Q

When thinking about red flags, which of the following is most likely to cause a headache in an immunocompromised patient?

1 - malignancy
2 - sub-arachnoid haemorrhage
3 - subdural bleed
4 - giant cell arteritis

A

1 - malignancy

48
Q

When thinking about red flags, which of the following is most likely to cause a persistent headache that then changes drastically?

1 - malignancy
2 - sub-arachnoid haemorrhage
3 - subdural bleed
4 - giant cell arteritis

A

1 - malignancy

This is very common in >50s

49
Q

When thinking about red flags, which of the following is most likely to cause a headache in a current or recent pregnancy?

1 - malignancy
2 - sub-arachnoid haemorrhage
3 - pre-eclampsia
4 - giant cell arteritis

A

3 - pre-eclampsia

50
Q

When thinking about red flags, which of the following is most likely to cause a headache that is associated with pain, specifically in the temporal region?

1 - malignancy
2 - sub-arachnoid haemorrhage
3 - pre-eclampsia
4 - giant cell arteritis

A

4 - giant cell arteritis

A. Block D Neurology (39 decks)

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