Clinical Medicine Final Written Lab Proficiency

Migraine Headaches

• A young female age 20-40 experiencing loss of appetite, nausea, vomiting, noise and light sensitivity

• The onset of HA was during puberty

• Aggravating factors are stress and vasoactive food (plums, avocados, bananas)

Classic Migraine

• 4 Phases

  • Premonitory Phase

    • 1 day

    • Patient feels depressed, irritable, restless, and different

  • Prodomal Phase (aura)

    • 10-40 min

    • visual disturbances like bright light, shimmery jagged lines

  • Pain Phase

    • Pain contralateral to the side of the aura

  • Recovery Phase

    • Euphoria upon relief

Common Migraine

No aura

Complicated Migraine

• Ophthalmoplegic

  • Oculomotorparesis

  • Pupil Involvement

  • Onset < 10

• Basilar

  • Age: 20’s

  • Bioccipital

  • Severe intensity

  • Blurred, foggy or “graying vision”, tunnel vision, hemianopsia, flashes of light, diplopia, ptosis, nystagmus, photophobia

  • (+) strong menstrual association

  • FHx: (+) strong

• Cerebral

  • Caused by presumed cerebral infarction

  • Homonymous hemianopsia/quandrantopsia

• Retinal

  • Transient or permanent monocular visual disturbances

  • FHx: (+) strong

Cluster Migraine

• Taylor’s HA

• The suicidal HA

• M > F ages 10-39

• F: In clusters, several times a day for 2-3 weeks, followed by a long remission

• L: Unilateral pain around the eye

• D: 1 hr

• A: Alcohol, heat, exericise

• I: Very severe & will awake a patient from a sound sleep

• S: Horner’s Syndrome

  • Ptosis

  • Anhydrosis

  • Mitosis

Migraine Equivalent / Isolated opthalmic (Acephalgic)

Hypertensive HA

Toxic HA

Which headaches are associated with hemianopsias?

• Complicated migraines (basilar, Cerebral)

• Migraine Equivalent/Isolated ophthalmic (Acephalgic)

Which headaches are associated with auras?

• Classic migraine

• Ischemic Cerebrovascular