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NEURO MIGRAINES

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◆ SYMPTOMS ● Classic Migraine (w/ aura) ○ First/Prodrome phase ◆ Aura that develops over period of several minutes and last no longer than 1 hr ◆ Transient focal neurologic dysfunction ◆ Visual disturbances, flashin ...

◆ SYMPTOMS ● Classic Migraine (w/ aura) ○ First/Prodrome phase ◆ Aura that develops over period of several minutes and last no longer than 1 hr ◆ Transient focal neurologic dysfunction ◆ Visual disturbances, flashing lights, lines or spots, shimmering or zigzag lights ◆ Numbness, tingling of lips or tongue, acute confusional state, aphasia, vertigo, unilateral weakness, drowsiness ○ Second phase: ◆ HA accompanied by N/V ◆ Pain beginning in temple, increase in intensity and becomes throbbing w/in 1 hr ○ Third phase ◆ Pain changing from throbbing to dull ◆ HA, N/V lasting 4-72 hrs ● Common Migraine (W/O aura) ○ Migraine before onset of HA ○ Pain aggravated by performing activities ○ Unilateral and pulsating ○ N/V, photophobia, phonophobia, HA lasting 4-72 hrs ○ Migraine in early morning, during stress, or in premenstrual tension or fluid retention ● Atypical Migraine ○ Migrainous: HA lasting longer than 72 hrs ○ Migrainous infarction: neurologic symptoms not completely reversible w/in 7 days ◆ Ischemic infarct noted on imaging ○ Unclassified: HA not fulfilling all the criteres to be classified a migraine ◆ TREATMENT ● Abortive Therapy ○ Acetaminophen, Ibuprofen, Naproxen, Exedrin ○ Triptan preparations (as soon as migraine S/S start) ◆ Sumatriptan (Imitrex) ◆ Eletriptan (Relpax) ◆ Naratriptan (Amerge) ◆ Almotriptan (Axert) ○ Ergotamine preparations ◆ Cafergot (Ergotamine) ◆ Dihydroergotamine (DHE)-Migranal ◆ Midrin ◆ MOA: constrict (vasoconstriction reduces blood flow in cerebral arteries) ➔ SEIZURES ● Preventative Therapy ○ Beta Blockers: Propranolol (Inderal), Timolol ◆ Do not stop abruptly ○ CCB: Verapamil (Calan) ○ AntiepilepticsL Topiramate (Topamax) ○ Tricyclic Antidepressant (Nortriptyline (Pamelor) ○ Botox ● DIETARY RESTRICTIONS (SATA) ○ Avoid tyramine-containing products (pickled products, aged cheese, caffeine, beer/wine, preservatives, artificial sweeteners) ○ Chocolate ○ Food w/ yeast (pastry and fresh breads) ○ MSG ○ Nitrates (meats), pickled or fermented foods ○ Nuts ○ Smoked fish ○ Yogurt ◆ PHASES: ● Preictal: Events that patient experiences before a seizure (aura) ○ Feeling of something not being right or about to happen ...............................................CONTINUED.................................

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