Term
| What are serotonin agonists? |
|
Definition
Triptan drug class:
zolmitriptan
Sumatriptin
eletriptan
rizatriptan |
|
|
Term
|
Definition
| serotonin agonists used for abortive migraine tx. |
|
|
Term
|
Definition
|
|
Term
| How are triptans administered? |
|
Definition
All can be oral
Rizatriptan and zolmitriptan can be sublingual
Sumatriptan and Zolmitriptan can be nasal |
|
|
Term
| What is dihydroergotamine? |
|
Definition
| IV or nasal spray migraine abortive tx |
|
|
Term
| What is the mechanism of action for the triptan drug class? |
|
Definition
| potent vasoconstrictor --> abortive migraine tx |
|
|
Term
| Why are ergotamine's not preferred over triptans? |
|
Definition
| Triptans are more effective, have fewer SE |
|
|
Term
| What is parenteral dexamethasone? |
|
Definition
| If triptans are not effective for migraine tx, these are added to boost the tx |
|
|
Term
| What are the anti-emetics used for? |
|
Definition
Migraine tx:
metoclopramide
chlorpromazine |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What are anti-convulsants used for migraine tx? |
|
Definition
Valproic acid
Gabapentin
Topiramate |
|
|
Term
| What are anti-depressants used for migraine tx? |
|
Definition
|
|
Term
| What are the classes of drugs used for migraine prevention? |
|
Definition
anti-convulstants
anti-depressants
Botox |
|
|
Term
| What are additional migraine tx's? |
|
Definition
Beta blocker propranolol
Verapamil: calcium channel blockers
Was suspected to stabilize blood vessels, though studies question their effectiveness |
|
|
Term
| What is the tricyclic anti-depressant we need to know? What is it's mechanism? |
|
Definition
amitryptyline
SSRI type mechanism |
|
|
Term
| What is a hemiplegic migraine? |
|
Definition
a type of migraine w/ aura
unilateral
mimics a stroke
familial
hemiparesis that lasts longer than the migraine itself. Recovery may take weeks, recovery usually complete |
|
|
Term
| Why does botox prevent migraines? |
|
Definition
|
|
Term
| What is the typical age of a hemiplegic migraine pt? |
|
Definition
| Under 45; Mimics a stroke, but younger age helps with ddx |
|
|
Term
| What is the tx for hemiplegic migraines? |
|
Definition
CCB's
NOT triptans due to vasoconstriction and concerns of stroke |
|
|
Term
| Why are triptans avoided with hemiplegic migraines? |
|
Definition
| Vasoconstriction properties would be bad if pt is having a stroke. |
|
|
Term
| What type of migraine has a controversial and not well agreed upon tx? |
|
Definition
|
|
Term
| What is the cause of retinal migraines? |
|
Definition
constriction of ophthalmic artery
or
central retinal artery |
|
|
Term
| Are retinal migraines common? |
|
Definition
|
|
Term
| Are retinal migraines binocular or monocular? |
|
Definition
|
|
Term
| How long does a retinal migraine last? |
|
Definition
|
|
Term
| What is often misdiagnosed as a retinal migraine? |
|
Definition
migraine aura w/o headache
The ddx is that retinal migraines will be monocular, not binocular |
|
|
Term
| What needs to be ruled out before retinal migraine dx? |
|
Definition
|
|
Term
| Who are typically affected by retinal migraines? |
|
Definition
|
|
Term
| Can migrainous infarction from a retinal migraine cause irreversible vision loss? |
|
Definition
|
|
Term
| How are true retinal migraines treated? |
|
Definition
|
|
Term
| What is a migraine aura w/o headache? |
|
Definition
| Common complaint of optometry pt's |
|
|
Term
| What is the prevalance of migraine aura w/o headache? What are traits of typical pts? |
|
Definition
6.5% of pt's >18
pt's affected generally have a family history
Pt generally has a childhood history of motion sickness |
|
|
Term
| How are migraine aura w/o headaches treated? |
|
Definition
|
|
Term
| What are trigeminal autonomic cephalgia s/sx? |
|
Definition
Ptosis
injection
Epiphora
Rinorrhea |
|
|
Term
| Do cluster headaches occur with extreme periodicity (i.e. they occur on the same day, same hour every year? |
|
Definition
|
|
Term
| How long does a cluster headache last? |
|
Definition
| 30 min to 3 hrs, but usually more around the 3 hours |
|
|
Term
| What is the prevalence of cluster headaches? |
|
Definition
1% of the population
men more than women |
|
|
Term
| What is the ratio of cluster headaches in men vs women? |
|
Definition
|
|
Term
| Where do cluster headaches typically present? |
|
Definition
| unilateral and periocular |
|
|
Term
| Do cluster headaches pulse? |
|
Definition
|
|
Term
| What is the onset of cluster headaches? |
|
Definition
|
|
Term
| Is there nausea and vomiting in cluster headaches? |
|
Definition
|
|
Term
| What is the pathophysiology of cluster headaches? |
|
Definition
Not well understood
May be hypothalamic dysfunction |
|
|
Term
| Why is hypothalamic dysfunction suspected in cluster headaches? |
|
Definition
Due to the extremely precise periodicity of cluster headaches
"same hour, same day, EVERY year" |
|
|
Term
| How are cluster headaches treated? |
|
Definition
Dihydroergotamine and serotonin agonists
cold air
100% O2 for 20 minutes
intranasal lidocaine
Verapamil for prophylaxis
neural stimulation |
|
|
Term
| What neural areas can be stimulated to treat a cluster headache? |
|
Definition
posterior hypothalamic stimulation
occipital nerve stimulation |
|
|
Term
| If a pt has a severe migraine and are very active pacing back and forth, what does that imply? |
|
Definition
| specific cluster headache |
|
|
Term
| What is paroxysmal hemicrania? |
|
Definition
| unilateral, brief but severe attack of pain with cranial autonomic features |
|
|
Term
| How common are paroxysmal hemicrania? Who are they prevalent in? |
|
Definition
Extremely rare
More prevelant in women |
|
|
Term
| How long does a paroxysmal hemicrania occur? |
|
Definition
2-30 minutes, but up to 2 hours. Generally short by migraine standards
Can occur up to 40x per day |
|
|
Term
| What drug can stop a paroxysmal hemicrainia migraine? |
|
Definition
|
|
Term
|
Definition
| brief attacks of severe unilateral head pain with autonomic symptoms |
|
|
Term
| What migraine syndrome attacks in a 'sawtooth' pattern? |
|
Definition
|
|
Term
| How many times in one day can a SUNCT syndrome HA occur? |
|
Definition
|
|
Term
| What are s/sx of SUNCT syndrome? |
|
Definition
conj injection and lacrimation
nasal congestion
rhinorrhea
ptosis
eyelid edema |
|
|
Term
| What can trigger SUNCT syndrome? |
|
Definition
| multiple triggers (touch, chewing, exercise, light, neck movement) |
|
|
Term
| What is the duration of one SUNCT syndrome attack? |
|
Definition
|
|
Term
| Does SUNCT syndrome have remission? |
|
Definition
| NO, this is a primary ddx |
|
|
Term
| What are tx's for SUNCT syndrome? |
|
Definition
IV lidocaine if the attack has already started
anti-convulsants to prevent
Surgery if sx have become debilitating |
|
|
Term
| What are anti-convulstants used to treat SUNCT syndrome? |
|
Definition
lamotrigine (first line)
topiramate
gabapentin |
|
|
Term
| What are surgical methods used to treat SUNCT syndrome? |
|
Definition
occipital nerve blockade
deep brain stimulation being studied |
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|
