Term
| What % of the population suffers from migraines? |
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Definition
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Term
| What is the prevalence of migraines in men vs women? |
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Definition
| 7:3; women more often than men |
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Term
| What is the peak age of occurrence for migraines? |
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Definition
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Term
| What % of migraines are unilateral? |
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Definition
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Term
| What % of migraineurs have a family history of migraines? |
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Definition
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Term
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Definition
| a recurrent HA a pt chronically suffers that involves nausea and pain |
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Term
| What is the prodrome phase? |
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Definition
| When a migraine episode first begins, there are generally 'stormclouds on the horizon' in the form of mood swings, food cravings, and neck pain |
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Term
| What does hemicrania mean? |
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Definition
| half a head', is the etymological basis for 'migraine' |
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Term
| Why are women more prone to headaches? |
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Definition
| Increased hormonal swings due to menstruation and the concurrent estrogen and serotonin swings. |
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Term
| What are s/sx of the prodrome phase? |
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Definition
mood swings hours to days before the HA
aversion to light, sounds, smells
food cravings, thirst, and urination
yawning
neck pain |
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Term
| What % of migraine sufferers will have an aura? |
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Definition
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Term
| How many recognized phases do migraines have and what are they? |
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Definition
5 -->
prodrome
aura
headache
resolution
postdrome |
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Term
| Will all pt's present all of the phases of migraines? |
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Definition
| no, occurrence may vary from pt to pt |
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Term
| In migraines, what are the auras like? |
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Definition
| Aura is visual, lasts ~20 minutes, if more than an hour it is probably a tumor, not a migraine |
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Term
| If a visual aura lasts more than an hour, what should be suspected? |
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Definition
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Term
| Are migraines vascular headaches? |
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Definition
| No, despite the throbbing nature |
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Term
| What can emesis trigger in migraines? |
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Definition
| It may resolve the migraine and indicate resolution phase is near |
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Term
| What is the postdrome phase of a migraine? |
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Definition
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Term
| What are characteristics of the postdrome phase of a migraine? |
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Definition
fatigue
scalp tenderness
loss of appetite |
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Term
| Do HA usually present as throbbing initially? |
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Definition
| No, usually a dull ache --> throbbing HA |
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Term
| What is the usual occurrence of migraines? |
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Definition
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Term
| What are internal triggers for migraines? |
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Definition
stress
hormonal changes
change in sleep habits |
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Term
| What are external triggers for migraines? |
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Definition
food
weather
trauma
motion
light
smells
sounds |
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Term
| What is the suspected pathology of migraines? |
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Definition
| neurovascular or neurogenic, not just 'vascular' as previously believed |
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Term
| What is reduced in migraine sufferers? |
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Definition
| GABA --> reduced threshold for neuronal activity |
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Term
| Are migraines passed genetically? |
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Definition
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Term
| What is central sensitization or 'kindling'? |
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Definition
The brain recognizes the s/sx of an oncoming migraine, so it will accelerate the course of the migraine
Each migraine then increases the frequency of the subsequent one |
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Term
| What are the hormonal roles in migraine onset? |
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Definition
| serotonin is depleted; dopamine is increased. |
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Term
| What causes many early prodromal sx? |
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Definition
| serotonin is depleted; dopamine is increased. |
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Term
| Once serotonin and dopamine is reduced, what neurotransmitter then induces a neuroexcitatory state? |
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Definition
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Term
| Once a migraine is initiated, what ganglion is activated? |
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Definition
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Term
| What does the trigeminovascular system do during a migraine? |
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Definition
| releases vasoactive neuropeptides |
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Term
| What neuroactive peptides does the trigeminovascular system release? |
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Definition
Calcitonin gene-related peptide
Substance P
Neurokinin A |
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Term
| What is CGRP associated with? |
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Definition
| It is the most powerful vasodilator in the body; also influences pain |
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Term
| What is Substance P associated with? |
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Definition
Pain --> 'P' for pain
vasodilation |
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Term
| What is neurokinin A associated with? |
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Definition
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Term
| What is the cascade due to depressed serotonin levels? |
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Definition
fatigue
mood
cognitive
musculoskeletal pain
vascular changes
pain |
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Term
| What is the cascade due to serotonin levels replenishing? |
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Definition
yawning
mood change
nausea
gastrokinetic changes
hypotension
vomiting
dyskinesias |
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Term
| What did a migraine with out aura used to be called? |
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Definition
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Term
| What % of migraines present without an aura? |
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Definition
|
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Term
| What are s/sx of 'migraines without aura'? |
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Definition
initiates upon awakening, then builds through the day
GI upset
chills |
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Term
| How long coes a 'migraine without aura' typically last? |
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Definition
|
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Term
| What were 'migraines with aura' previously called? |
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Definition
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Term
| If an aura lasts less than 5 minutes, what should be suspected? |
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Definition
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Term
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Definition
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Term
| What is 'fortification scotoma'? |
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Definition
| A 'fort shaped' light show seen in the aura that precedes a migraine |
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Term
| What kind of vision loss is associated with migraines with aura? |
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Definition
hemianopsias and quadranopsias
Restores as aura subsides |
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Term
| When does the migraine generally come after the aura? |
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Definition
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Term
| How do migraines link to MI and stroke risk? |
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Definition
| Migraines indicated increased risk for MI and stroke |
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Term
| What % of migraines with aura present with GI upset and N&V? |
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Definition
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Term
| What are possible serious SE of migraines with aura? |
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Definition
| paresthesias and hemipareses |
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Term
| How long does a 'migraine with aura' typically last? |
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Definition
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Term
| What is a chronic migraine also called? |
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Definition
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Term
| What is the occurrence of chronic migraines? |
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Definition
| Migraine seen either other day for 3 months |
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Term
| What is a medication overuse headache? |
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Definition
| body desensitizes to analgesics with chronic use, so pt takes even more which simply fuels the cycle |
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Term
| In a chronic migraine, what is the nature of the symptoms? |
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Definition
| They become less severe as frequency increases |
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Term
| How are chronic migraines treated? |
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Definition
| preventive medications; best if migraine never gets started |
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Term
| What are the tx approaches for chronic migraines? |
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Definition
non pharmacologic
acute pain relief
abortive therapy
anti-emetics
preventive therapy |
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Term
| What are non-pharmacologic tx's for migraines? |
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Definition
Regular sleep
regular meals
regular exercise
healthy lifestyle
biofeedback --> relaxation and stress reduction
acupuncture
magnetic pulse during aura (?) |
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Term
| What are OTC medications and NSAID's for migraines? |
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Definition
Excedrin
ibuprofen
high-dose ASA |
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Term
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Definition
| caffeine, acetaminophen and aspirin |
|
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Term
| What migraine OTC tx is no longer recommended? |
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Definition
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Term
| What are narcotics used to tx migraines? |
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Definition
butorphanol
percocet
percodan |
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Term
| Should migraine narcotics be used commonly? |
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Definition
| No, should be used sparingly if at all. Believed to increase prediliction for further migraines |
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