-
How much of the population is affected by migranes?
10-20%
-
How many people who have migranes have ever consulted their doctor about their migrane?
2/3
-
Is a migrane a leading disabling medical illness according to WHO?
yes
-
What is the ratio of children males to females who suffer from migranes?
Adults?
-
How long can a migrane last?
4-72 hours
-
What are the requirements for a migrane headache?
- Two of the following: unilateral pain, throbbing, aggrevation on movement, pain of moderate/severe intensity
- One of the following: nausea/vomiting, photophobia/phonophobia
-
What are the four things that must be assessed to make a migrane diagnosis?
- Medical Hx
- Headache Diary
- Migrane Triggers
- Exclusion of secondary causes: EEG, MRI, CT
-
What are the phases of an acute migrane headache?
- Prodrome
- (aura)
- Headache
- Postdrome
-
When does a prodrome happen relative to the headache in a migrane?
12-36 hours before. but only last 15-20 minutes
-
What are the symptoms of the prodrome stage of a migrane headache?
- craving/distaste for certain foods
- lethargy
- yawning
- excitation/depression
-
What is an aura?
- a warning or signal immediately before the onset of a headache that does not alway occur in migranes
- duration=15-30 minutes
-
What are the symptoms of an aura?
- flashing lights
- zig-zag lines
- difficulty focusing
-
What are the accompanying symptoms of a migrane headache?
- anorexia
- phonophobia
- photophobia
- tinnitus
- nausa
- vomiting
-
How long can the postdrome phase of a migrane last?
few hours- 2 days
-
What are the symptoms of a postdrome phase of a migrane headache?
- fatigue
- depression
- severe exhaustion/feeling fresh
-
What is a common migrane?
Migrane without aura
-
What is a classic migrane?
Migrane with aura
-
What is the diagnosis of a complicated migrane?
includes migrane + other symptoms, such as tremor
-
What classification does serotonin/5-hydroxytryptamine fit into?
indoleamine
-
Where is serotonin located?
- in the GI enterochromaffin cells(90%)
- on platelets
- in the brain
-
How is serotinin synthesized?
- from tryptophan consumed in the diet
- it takes two step to make serotonin from tryptophan
-
Why is measuring serotonin in the blood not a good method for determining the brain's supply of serotonin?
B/c not distributed equally~very large amounts in the GI tract
-
How many different types of serotonin receptors exist in the body?
at least 15
-
What kind of receptors are serotonin receptors?
G-protein receptors with one exception: 5-HT3, which is ligand gated
-
What does the serotonin receptor 5-HT1A play a role in?
anxiety/depression
-
What does the receptor 5-HT1D play a role in?
migranes
-
What does the receptor 5-HT3 play a role in?
nausea/vomitting
-
What are the two types of autoreceptors found in serotonigeric neurons?
- somatodendritic autoreceptors: 5-HT1A
-
What are the pharmacological/physiological effects of serotonin?
- GI tract/small intestine
- vomiting b/c of vagal afferents chemo-receptor trigger zone
- vasoconstriction
- platelet aggregation
- Bezold Jarrisch Reflex
-
What is the Bezold Jarrisch Reflex?
stimulation of sensory nerve endings by serotonin in baroreceptors and vagal afferents in coronary circulation leading to bradycardia and hypotension
-
What kind of tumor presents with diarrhea, bronchoconstriction, and edema due to large amounts of serotonin release?
carcinoid tumors
-
What are the roles of serotonin in the CNS?
- pain perception
- sleep/wakefulness
- behaviors (disorders include: depression, schizophrenia, OCB
- neuroendocrine regulation
-
Where does the pain from migrane headaches come from?
- the vasodialation of vasculature
- remember brain parynchema is insence
-
Are migranes a vascular disorder or a CNS disorder?
CNS....obviously?
-
What is the pathophysiology of a migrane headache?
neural events trigger symptoms and produce dialation of blood vessels, which, in turn causes pain and further neuronal activation
-
All genes that have been connected to migrane headaches encode for what?
- neuronal proteins
- this is why it is a CNS disorder!
-
What does the gene CACNL1A4 code for and what kind of mutation does it need to produce hemiplegic migranes?
- alpha1 subunit of brain specific P/Q-type Ca++ channels
- gain of function mutations would cause a hemiplegic migrane
-
What does the ATP1A2 gene code for and what kind of mutation of this gene would result in a hemiplegic migrane?
- alpha2 subunit Na+/K+ pump in astrocytes
- loss of function of this gene would cause hemiplegic migranes
-
What does the gene SCN1A code for?
neuronal voltage gated Na+ alpha subunit
-
What are tryptans used to treat?
Acute migranes
-
What are the mechanisms of tryptans?
- cranial vasoconstriction
- peripheral neuronal inhibition
- inhibit transmission via neurons of the trigeminocervical complex
-
What effect do triptans have on CGRP?
they are antagonists and prevent CGRP from being released
-
What are some adverse effects of triptans?
- tingling/parathesias
- sensations of warmth
- dizziness
- flushing
- neck pain/stiffness
- chest pains due to coranary artery constriction
-
Are triptans really that effective at relieving migranes?
No; recall study where only two drugs showed any improvement at all
-
What are four non-specific treatments for migranes?
- aspirin
- acetaminophen
- naproxen
- ibuprofen
-
What are the requirements for prophylaxis for migrane sufferers?
- >2 headaches a month
- duration>48 hours
- severity is extreme
- prolonged auras
- do not respond to normal therapy
- risk of permanent neurological injury
-
What is the gold standard for prophylaxis medication for migranes?
propanolol/beta-blockers
-
What is the starting dose for propanolol?
40-80 mg/daily
-
What is the maximum dose for propanolol?
240mg/day
|
|
