Migraine

Question 1

What is primary vs. secondary classification of headache

Answer 1

Primary: symptom based
Secondary: etiology based

Question 2

what are primary headaches

Answer 2

hundreds: tension, migraine, cluster etc

Question 3

what is most common headache and most common physician visit headache

Answer 3

most common: tension

most visited: migraine

Question 4

prevalence and sex of migraine

Answer 4

4 million canadians - 3:1 women:men

Question 5

when is migraine peak

Answer 5

25-55 years

Question 6

2 major subtypes of migraine

Answer 6

1. without aura (75%)

2. with aura

Question 7

why may women be more effected

Answer 7

estradiol decrease at menstruation may play a role, but not only factor

Question 8

what is problem with episodic headache and how often

Answer 8

if not treated, can become chronic – 3% each year

Question 9

7 modifiable risk factors for chronic migraine

Answer 9

1. attack frequency
2. obesity
3. med overuse (>2/wk)
4. stress response
5. disordered sleep
6. dep/anx
7. allodynia

Question 10

what are migraine without aura crit

Answer 10

A. 5 attacks fulfilling B-D
B. headaches lasting 4-72 hrs
C. 2 of: unilateral, pulsating, mod to severe pain, agg by activity
D. 1 of nausea/vomiting, photophobia/phonophobia

Question 11

migraine with aura crit

Answer 11

same as without but:
B. reversible sensory or speech Sx
C. 2 of unilateral Sx, 5 minute development, 5-60 minutes Sx

Question 12

what is contraindication of aura

Answer 12

birth control pill

Question 13

what is IC headache classification

Answer 13

any 2: unilateral, throbbing, worsened by act, mod or severe

+1: nausea or vomiting, photo or phonobia

Question 14

what is migraine prodrome

Answer 14

12-24hrs before - mood swings, choc cravings, yawning

Question 15

co-existing disorders (4)

Answer 15

1. IBS
2. anxiety,
3. depression
4. poor sleep

Question 16

common triggers

Answer 16

1. weather
2. poor sleep
3. weekend/holidays
4. menses
5. strong smells
6. stress
7. skipping meals

Question 17

what is migraine patho (5)

Answer 17

1. genetic predisp
2. cortical neuronal hyperexcitability
3. cortical spreading depression
4. trigeminovascular system activated
5. prolonged headache pain of migraine

Question 18

3 keys to true sinus headache

Answer 18

1. face pain
2. worse lying down
3. discharge/fever

Question 19

what is med overuse headache prev

Answer 19

1.5%

Question 20

what are meds overused

Answer 20

1. tylenol, ibuprofen – +2days/wk
2. codeine, narcos, 5-8 doses/month
3. triptans - 10days/month

Question 21

what do patients want in a medication

Answer 21

1. complete releif

2. pill form

Question 22

what are 3 components to treatment

Answer 22

1. education
2. lifestyle mod
3. vitamins/herbal

Question 23

3 steps to med mgmt

Answer 23

1. intial therapy
2. if fail - back-up
3. if fail - rescue

Question 24

what is specific MOA drug

Answer 24

triptans - 5HT 1B/D - most effective early

Question 25

what are non-specific

Answer 25

1. NSAIDs 2. analgesics 3. corticosteroids 4. antiemetics

Question 26

what are tripan SEs

Answer 26

1. most mild -chest pressure, CNS effects | 2. serotonin syndrome - rare

Question 27

what are 5 goals of preventative therapy

Answer 27

1. not to be headache free 2. reduce headaches by 50% 3. reduce acute meds 4. increase acute med effectivemness 5. prevent chronification of headaches