Migraines, Insomnia, and Seizures Lecture Review

Flashcards covering vocabulary and core concepts from the lecture on migraines, insomnia, and seizures, including medications, diagnosis, and clinical characteristics.

Vascular emergency headache

Headache associated with vascular problems such as hypertensive crisis, stroke, or intracranial bleeding.

Ergotamine

Migraine medication that causes prolonged cranial vasoconstriction and inhibits neurogenic inflammation.

Status epilepticus treatment

Benzodiazepines followed by IV antiepileptic drugs.

Headache

Most common neurologic symptom; may be vascular, muscle-contraction, or combination and ranges from mild to severe.

Red flag headache

A headache that may indicate a serious underlying condition such as hemorrhage, infection, tumor, or increased intracranial pressure.

Thunderclap headache

Sudden severe headache described as the "worst headache of my life"; classic sign of subarachnoid hemorrhage.

Space-occupying headache

Caused by mass effect or increased intracranial pressure such as brain tumor, brain abscess, or swelling.

Infectious headache

Headache associated with infection such as meningitis or encephalitis and often accompanied by fever and stiff neck.

Tension headache

Band-like pressure headache caused by muscle tension or stress and usually mild to moderate in severity.

Migraine headache

Moderate to severe unilateral throbbing headache associated with nausea, vomiting, photophobia, and phonophobia.

Cluster headache

Severe unilateral headache around the eye accompanied by autonomic symptoms such as tearing, nasal congestion, ptosis, or miosis.

Migraine aura

Neurologic symptoms such as visual flashes, smells, or sensory changes that occur shortly before a migraine.

Migraine triggers

Factors that can precipitate migraines including stress, hormonal changes, flashing lights, strong odors, certain foods, and sleep disturbances.

Migraine abortive therapy

Medication taken at the onset of a migraine attack to stop or reduce symptoms.

Migraine preventive therapy

Medication taken regularly to reduce the frequency and severity of migraines.

NSAIDs (migraine treatment)

Drugs that inhibit cyclooxygenase (COX) enzymes and decrease prostaglandin production to reduce inflammation and pain.

Acetaminophen

Mild analgesic that works through central pain inhibition and is commonly used for mild migraine treatment.

Caffeine (migraine therapy)

Enhances analgesic absorption and causes cerebral vasoconstriction to improve headache relief.

Medication-overuse headache

Rebound headaches caused by frequent use of analgesics or migraine medications.

Triptans

Class of drugs that are selective serotonin ($5\text{-HT}_{1B/1D}$) receptor agonists causing cranial vasoconstriction to treat acute migraine.

Sumatriptan

Prototype triptan used for acute migraine attacks.

Triptan contraindications

Conditions such as coronary artery disease, stroke history, uncontrolled hypertension, or peripheral vascular disease.

Serotonin syndrome

Potentially life-threatening condition caused by excessive serotonin activity; may occur when triptans are combined with SSRIs or SNRIs.

Ergotamine precautions

Contraindicated in cardiovascular disease, pregnancy, and uncontrolled hypertension due to ischemia risk.

Insomnia

Inability to fall asleep, stay asleep, or feel refreshed after sleep.

Acute insomnia

Short-term insomnia lasting days to weeks.

Chronic insomnia

Insomnia lasting longer than one month.

Non-restorative sleep

Sleep that does not provide adequate recovery due to CNS hyperarousal and disrupted sleep cycles.

Sleep hygiene

Behavioral practices that improve sleep such as avoiding caffeine before bed, maintaining routine sleep times, and reducing nighttime stimulation.

Sedative-hypnotics

Drugs that depress the central nervous system to promote sleep.

Tolerance

Reduced drug effectiveness over time requiring higher doses for the same effect.

Dependence

Physiologic or psychological need for a drug that may cause withdrawal symptoms if discontinued.

GABA

Gamma-aminobutyric acid, the primary inhibitory neurotransmitter in the central nervous system.

Benzodiazepines

Drugs that enhance GABA activity at GABA-A receptors to produce sedation and decrease neuronal excitability.

Temazepam

A benzodiazepine commonly used short term for insomnia.

Benzodiazepine mechanism

Increases GABA activity causing chloride channel opening and neuronal hyperpolarization.

Hyperpolarization

Increase in negative charge inside a neuron that reduces the likelihood of neuronal firing.

Flumazenil

Benzodiazepine antidote used to reverse benzodiazepine toxicity.

Benzodiazepine black box warning

Combining benzodiazepines with opioids or alcohol can cause severe respiratory depression and death.

Zolpidem

Non-benzodiazepine sedative-hypnotic used for short-term treatment of insomnia.

Zolpidem serious risks

Complex sleep behaviors such as sleep-walking or sleep-driving and worsening depression.

Ramelteon

Melatonin receptor agonist used to regulate circadian rhythm and treat sleep initiation insomnia.

Melatonin receptor agonist mechanism

Stimulates $MT_1$ and $MT_2$ receptors to regulate circadian rhythm and promote sleep.

Seizure

Transient abnormal electrical activity in the brain causing changes in behavior, movement, or consciousness.

Epilepsy

Chronic neurologic disorder characterized by recurrent unprovoked seizures.

Prodromal phase

Early warning phase occurring hours to days before a seizure with mood or behavioral changes.

Aura

Brief sensory warning before a seizure such as visual disturbances or unusual smells.

Ictal phase

Active seizure period characterized by abnormal motor or neurologic activity.

Postictal phase

Recovery phase after a seizure marked by confusion, fatigue, and headache.

Focal seizure

Seizure originating in one area of the brain.

Tonic-clonic seizure

Generalized seizure with loss of consciousness and rhythmic muscle contractions.

Absence seizure

Brief seizure characterized by sudden staring and brief loss of awareness without postictal confusion.

Atonic seizure

Sudden loss of muscle tone causing a drop attack.

Status epilepticus

Seizure lasting longer than $5$ minutes or repeated seizures without recovery between episodes.

EEG (electroencephalogram)

Test that records electrical activity of the brain using scalp electrodes to support seizure diagnosis.

Antiepileptic drugs (AEDs)

Medications used to reduce neuronal hyperexcitability and control seizures.

AED withdrawal risk

Abrupt discontinuation can trigger rebound seizures or status epilepticus.

Traditional AEDs

Older antiepileptic drugs with more side effects and drug interactions (phenytoin, carbamazepine, valproic acid).

Newer AEDs

Newer antiepileptic drugs with fewer side effects and interactions (levetiracetam, gabapentin).

Phenytoin

Antiepileptic drug that blocks sodium channels to stabilize neuronal membranes.

Phenytoin toxicity sign

Ataxia is a classic early sign of toxicity.

Phenytoin therapeutic level

$$10-20\,mcg/mL$$

Purple glove syndrome

Severe tissue injury caused by IV phenytoin infiltration.

Carbamazepine

Antiepileptic drug also used for trigeminal neuralgia and bipolar disorder.

Carbamazepine monitoring

Monitor CBC due to risk of leukopenia, anemia, and thrombocytopenia.

Valproic acid

Antiepileptic drug that increases GABA and decreases neuronal excitability.

Valproic acid major risk

Hepatotoxicity requiring monitoring of liver function tests.

Levetiracetam

Newer AED with fewer drug interactions and primarily renal elimination.

Gabapentin

AED that modulates calcium channels and reduces excitatory neurotransmitter release.

AED patient teaching

Avoid alcohol, take medications consistently, and never stop abruptly without tapering.