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25 Cards in this Set
- Front
- Back
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What are the characteristics of a migraine?
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occurs periodically
pain the head (usu. unilateral) vertigo nausea vomiting photophobia scintillating appearance of light |
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What is the difference between a common migraine and classic migraine?
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Common migraine doesn't have an aura, classic does
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What is a tension headach?
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Band like sensation around the head
Bilateral not aggravated by activty associated with nervous tension, anxiety, etc chronic contractino of scalp muscle relieved by relaxation and simple analgesics (NSAIDs and paracetamol |
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What is a cluster headache?
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vascular headache syndrome
reccurrent severe unilateral orbitotemporal headaches ipsilateral photophobia, lacrimation and nasal congestion, lid ptosis and nausea peak in 5 mins Deep non-flucuating and explosive Rarely pulsitle 30mins-2hrs duration Provoked by alcohol (vulernability is pathognomonic) Rarely do food or emtional factos ppt pain (unlike migraine) |
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Who are more likely to suffer a tension heahache?
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W =2xM
most people get it once in a lifetime |
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who gets migraines and what is the proportion of people who get classical migraine?
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10% male + 20% familes = once in their life
25% of sufferes date onset of attacks from childhood Aura in 20% of cases |
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Wjat are the risk factors for migraine?
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1) Genetics: MELS and FHM -dysfunction of ion channels
2) Female 3) CHOCOLATE: CHees, Oral contraceptive pill, Caffine, alcohOL, Anxiety, Travel, Exercise 4) sudden stress/relaxation after stress 5) Fatty food, chesse, red wine and orange |
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What chromosome is FMH assigned to and what is the basis of that?
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chrm 19p13
mutation involving voltage gated calcium channel gene FMH-1 is responsible for about 50% of idenified familes. |
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Describe the aura phase of a migraine
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1) Cortical spreading depression triggered by K+ induced depolarisation and glutamate NMDA receptor activation (glutamate released from depolarisation)
2) brief wave of neuro excitation and neuro inhibition 3) tissue hyperoxia -> intracranial arteriolar vasconstriction -> decrease regonal blood flow Last's for approx 10mins progressing at 2-6mm/min |
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Describe the headache phase of migraines
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Reflex dilation -> distortion of vessels + local inflammation -> pain receptors triggered -> trigeminal nucleus -> C1, C2, C3
1) pain to spinal trigeminal ganglia -> 2nd order neurones -> higher pain centres 2) referred pain to upper neck and occiput |
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What are the clinical features of common migraine?
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moderate to severe pain (peak 1hour)
4-24 hours pulsating N&V photo and phono phobia relieve by sleep Onset -early morning/daytime |
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Clinical features of classical migraine?
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aura: sensory, motor, visual
visual (pathognomonic) 30mins dysfunction of occipital lobe |
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Clinical features of cluster headache
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Unilateral
periorbital or temporal pain Peaks 5 mins 30mins -5hours deep, non-fluctuating, explosive same side for subsequent months Provoked by EtOH (pathognomonic) |
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Clinical features of tension headache
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Bilatera
band like around head not aggravated by activity relieved by relaxation and simple analgesics F>M |
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What the difference between the common migraine and classical migraine in terms of the headache phase?
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In common migraine, the headache is often poorly localise
May be confused with tension headache |
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What tests would you do to exclude other DDx for migraine?
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ESR for temporal arteritis
LP -for encephailtis/meningitis |
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What is the acute treatment/management of migraines?
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Fluid replacement (severe N&V)
Ergot alkaloids (ergotamine, dihydroergotamine) = high affinity for adrenoreceptors + 5HT receptors Triptans (sumatriptans) = high affinity for 5HT receptors Antinauseants, anti-emetics + gastrokinetic drugs (metoclpramide, domperidone) Analgesics -paracetamol, NSAIDs |
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What is the effect of Ergot alkaloids?
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Cranial vasoconstriction
Decrease release of neurogenic inflammation peptides undefined CNS effects |
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What is the effect of Triptans?
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5HT1 agonist
intracranial vasoconstriction decrease release of neurogenic inflammatory peptides inhibit trigeminocervial nuclei SE: vasconstriction in other body systems |
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What drugs can be given to prevent migraines?
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Pizotifen
Propanolol Naproxen, ibuprofen Amitriptyline |
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What is the mechanism of pizotifen in the use of preventing migraines?
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5HT2 receptor antagonist
block cerebral arteriolar vasoconstriction (? suppress spreading hypoperfusion) |
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What is the mechanism of propanolol in the use of preventing migraines?
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beta adrenoreceptor antagonist
?suppression of cortical spreading depression via blocking in central catecholamine pathway |
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What is the mechanism of naproxen in the use of preventing migraines?
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analgesics
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What is the mechanism of amitriptyline in the use of preventing migraines?
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Tricyclic antidepressant
?specific analgesic effect in CNS lesion pain |
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What are the red flags to migraine
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New or different headache
new headache after 40years Fever with neck stiffness Abrupt onset Altered consciousness Persistant focal neuro signs Significant head trauma Anticoagulant use Immune suppression Seizures |
