Diagnosis of Migraine
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Questions and Answers

What is a headache?

  • A symptom that can be caused by a single disorder
  • A persistent or lasting pain in the head region (correct)
  • A symptom that can only be caused by inflammation of pain-sensitive structures within the head
  • A type of brain tumor

    • What is a primary headache?

  • A headache characterized by the lack of an identifiable and treatable underlying cause (correct)
  • A headache that is caused by disorders of extra-cranial structures such as the eyes, ears, or sinuses
  • A headache that is associated with a migraine
  • A headache caused by a variety of organic disorders

    • What is a characteristic of a migraine headache?

  • It is usually sudden in onset and lasts for a few seconds
  • It is usually severe and associated with numbness, tingling, and weakness
  • It is usually gradual in onset and peaking in intensity over minutes to hours (correct)
  • It is usually bilateral and constant in nature

    • What is the duration of an untreated migraine headache?

    <p>Between 4 and 72 hours</p> Signup and view all the answers

    What percentage of migraineurs experience premonitory symptoms?

    <p>77%</p> Signup and view all the answers

    What type of visual auras can occur in migraine?

    <p>Both positive and negative features</p> Signup and view all the answers

    What is the duration of a migraine aura?

    <p>Between 5 to 20 minutes</p> Signup and view all the answers

    What is the timing of a headache in relation to the aura?

    <p>The headache usually occurs within 60 minutes of the end of the aura</p> Signup and view all the answers

    What is a common abnormality to check for in a neurologic examination?

    <p>Abnormal mental status</p> Signup and view all the answers

    What percentage of migraineurs experience a migraine aura?

    <p>31%</p> Signup and view all the answers

    What type of blood test may be considered in secondary headache presentation?

    <p>All of the above</p> Signup and view all the answers

    What is a common non-pharmacological method of managing migraine?

    <p>All of the above</p> Signup and view all the answers

    What is the purpose of keeping a headache diary?

    <p>To identify patterns and triggers</p> Signup and view all the answers

    What is a potential consequence of taking over-the-counter analgesic medications too frequently?

    <p>Medication overuse headache</p> Signup and view all the answers

    What is the purpose of administering an antiemetic prior to acute migraine therapy?

    <p>To reduce nausea and vomiting</p> Signup and view all the answers

    What type of medication is effective as first-line treatment for mild to moderate migraine attacks?

    <p>Simple analgesics and NSAIDs</p> Signup and view all the answers

    Study Notes

    Headache

    • A general term referring to a persistent or lasting pain in the head region
    • Can be caused by many disorders, such as inflammation of pain-sensitive structures within the head or disorders of extra-cranial structures like the eyes, ears, or sinuses

    Types of Headaches

    • Primary headache: characterized by the lack of an identifiable and treatable underlying cause
    • Secondary headache: associated with a variety of organic disorders, such as trauma, cerebrovascular malformations, and brain tumors

    Migraine

    • Characterized by recurring episodes of throbbing head pain, frequently unilateral
    • Can be severe and associated with nausea, vomiting, and sensitivity to light, sound, and/or movement
    • Typically occurs in the early morning hours on awakening
    • Pain is usually gradual in onset, peaking in intensity over minutes to hours, and lasting between 4 and 72 hours untreated

    Migraine Characteristics

    • Pain is typically reported as moderate to severe
    • Most often involves the frontotemporal region
    • Headache is typically unilateral and throbbing or pulsating in nature
    • About 77% of migraineurs have premonitory symptoms (not to be confused with aura) in the hours or days before the onset of headache

    Premonitory Symptoms

    • Neurological symptoms: phonophobia, photophobia, hyperosmia, difficulty concentrating
    • Psychological symptoms: anxiety, depression, euphoria, irritability, drowsiness, hyperactivity, and restlessness
    • Autonomic symptoms: polyuria, diarrhea, constipation
    • Constitutional symptoms: stiff neck, thirst, food cravings, anorexia

    Migraine Aura

    • Experienced by approximately 31% of migraineurs
    • Typically evolves over 5 to 20 minutes and lasts less than 60 minutes
    • Headache usually occurs within 60 minutes of the end of the aura
    • Visual auras can include both positive features (e.g., scintillations, photopsia, teichopsia, fortification spectrum) and negative features (e.g., scotoma, hemianopsia)

    Diagnosis of Migraine

    • Check for abnormalities: vital signs (fever, hypertension), fundoscopy (papilledema and hemorrhage), neurologic examination (abnormalities or deficits in mental status), neuroimaging (computed tomography or magnetic resonance imaging), and laboratory tests
    • In secondary headache presentation, serum chemistries, and other blood tests, such as a complete blood count, antinuclear antibody titer, ESR, and thyroid function tests may be considered

    Non-Pharmacological Management of Migraine

    • Keep a headache diary to identify patterns/triggers
    • Increasing hydration
    • Regular sleep
    • Regular exercise
    • Cognitive behavioral therapy
    • Biofeedback
    • Wearable devices

    Pharmacological Management of Migraine

    • Beta-blockers
    • NSAIDS
    • Anticonvulsants
    • Triptans
    • Dihydroergotamine
    • Calcium channel blockers
    • tricyclic antidepressants
    • Antiemetics (e.g., metoclopramide, chlorpromazine, or prochlorperazine)
    • Non-oral treatments (e.g., rectal suppositories, nasal spray, injections) may be advisable when nausea and vomiting are severe

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    Description

    This quiz covers the diagnosis of migraine, including visual auras, positive and negative features, and abnormalities to check for such as vital signs, fundoscopy, and neuroimaging.

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