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?

Between 4 and 72 hours Signup and view all the answers

What percentage of migraineurs experience premonitory symptoms?

77% Signup and view all the answers

What type of visual auras can occur in migraine?

Both positive and negative features Signup and view all the answers

What is the duration of a migraine aura?

Between 5 to 20 minutes Signup and view all the answers

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

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

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

Abnormal mental status Signup and view all the answers

What percentage of migraineurs experience a migraine aura?

31% Signup and view all the answers

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

All of the above Signup and view all the answers

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

All of the above Signup and view all the answers

What is the purpose of keeping a headache diary?

To identify patterns and triggers Signup and view all the answers

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

Medication overuse headache Signup and view all the answers

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

To reduce nausea and vomiting Signup and view all the answers

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

Simple analgesics and NSAIDs 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.