Basics of Migraines
This neurotransmitter is thought to play a role in migraines.
Serotonin
What medication should be avoided in an adolescent who experiences migraines with aura?
Estrogen-containing oral-contraceptives
What are the 2 first-line medications for mild to moderate migraine attacks?
NSAIDs or Tylenol
Use with an anti-emetic if nausea is present.
What is the frequency of headaches that may warrant preventative therapy?
1 headache per week, or 3-4 headaches per month
7 yo presents with fever, stiff neck, and altered mental status
meningitis
How long does a migraine need to last to meet criteria for migraine in children?
2 hours to 72 hours
Aura is a visual or sensory disturbance that can occur at what point in time in relation to a migraine headache?
Aura can occur before, during, or after a migraine headache, but must be within <1 hour of the headache.
Class of medications used for acute-treatment of severe migraines or migraine headaches resistant to OTC analgesics
Triptans
This preventative medication may cause dry mouth, dry eyes, lightheadedness, dizziness, constipation, increased appetite, somnolence, and prolonged QT
Amitryptiline – TCA anti-depressant
When full dose is achieved, migraine severity is reduced by 80-90%
8 year old presents with new-onset headache <1 month in duration, seizures, headaches awakening a child from sleep and new-onset gait abnormalities
Space-occupying lesion of brain
Name 2 of the characteristics that are required in diagnostic criteria for migraine without aura.
List at least 3 different types of aura seen in pediatric migraines.
Visual, Sensory, Motor, Brainstem, or Retinal
Non-pharmacologic treatment options for migraines
Rest or sleep in dark quiet room with cool cloth to forehead, muscle relaxation techniques like shoulder rolls
Name 4 anti-epileptics helpful in preventing migraine headaches
Topiramate, Valproic Acid, Keppra, Zonisamide, Gabapentin
17 yo obese female with severe acne presents with new-onset severe headache, double vision and abducens palsy
Idiopathic intracranial hypertension
List 3 unusual forms of migraine headaches.
Migraine with Brainstem Aura (previously known as Basilar artery migraine), Hemiplegic migraine (weakness on 1 side of body), Ophthalmologic Migraine (abnormal eye movements), Confusional Migraine (confused state lasting for hours).
What is the typical duration of aura?
5-60 minutes
Complication that can occur if you do not limit acute migraine medications to less than 10 per month.
Medication overuse headache
Identify 4 key lifestyle modifications helpful in preventing migraine headaches
(1) achieving good sleep hygiene (2) well-balanced diet – limiting caffeine and not skipping meals (3) hydration – 1-2 L fluid intake/day (4) regular exercise
15 y/o with h/o lupus, presents with new-onset severe headache, 10 minutes upon arrival develops generalized tonic-clonic seizures
Hypertensive Emergency
Name the 3 phases of a migraine attack.
Name 2 key clinical features of aura.
Gradual spread, progression of at least 1 symptom, fully reversible
Triptans should be used with caution in which 2 types of migraines?
Migraines with brainstem aura and Hemiplegic migraine (theoretical concerns about aggravating symptoms that may be caused by vasospasm).
This treatment option can be helpful in pediatric migraineurs who have failed two or more preventive options with intractable migraines, but is only currently FDA approved for adults
Botulinum toxin A injects
This syndrome is characterized by transient headaches, neurologic deficits, and CSF lymphocytosis
Syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL)