Migraine
Perceptions are intensified in mania, migraine, hallucinogen use and delirium.
What our notes say
- Perceptions are intensified in mania, migraine, hallucinogen use and delirium. (Psychiatry Year 6 CAT: June 2023, psychopathology, psychosis, mood and child psy)
- Migraine with aura raises the risk of ischaemic stroke, and oestrogen adds to that risk, so combined methods are contraindicated (WHO category 4). (Obstetrics and Gynaecology Question Bank: 12 Clinical MCQs)
- Ergotamine is used in migraine because of vasoconstriction of cranial vessels (Medical Virology & Mycology Paper Two 2022/2023 — MKU MBMM 3300 Questions & Answ)
- Differential diagnosis: hypoglycaemia, seizure with Todd's paralysis, migraine with aura, intracranial tumour or abscess, subdural haematoma, encephalitis, hypertensive encephalopathy, conversion disorder. (Internal Medicine (MBIM 4100) main exam, Paper One: 3 July 2019)
- | Functional | (1) Non-structural abnormality of function, e.g. migraine; (2) psychiatrically-induced neurological abnormality, e.g. hysterical conversion | (CNS History Taking & Neurological Exam Guide | Clinical Skills)
- Functional — (1) non-structural e.g. migraine; (2) psychiatrically induced e.g. hysterical conversion (CNS & Abdominal Exam: Clinical Techniques, History & Neurology)
Study material on Migraine
Practice questions on Migraine
Sumatriptan is effective in treating acute migraine attacks because it
- Blocks 5-HT2A receptors causing vasodilation
- Acts as a 5-HT1D agonist decreasing serotonin release
- Inhibits prostaglandin synthesis
- Blocks CGRP receptors
Answer: B. Sumatriptan is a selective 5-HT1D receptor agonist. Activation of presynaptic 5-HT1D receptors inhibits serotonin release and causes vasoconstriction of cranial vessels, both contributing to relief of acute migraine symptoms. ---
Methysergide is used in migraine prophylaxis but can cause which serious adverse effect with long-term use?
- Agranulocytosis
- Retroperitoneal and cardiac valve fibrosis
- Hepatotoxicity
- Nephrotoxicity
Answer: B. Methysergide, a non-selective 5-HT antagonist, can cause serious fibrotic complications including retroperitoneal fibrosis, pleuropulmonary fibrosis, and cardiac valve fibrosis with prolonged use. Due to this risk, it requires drug holidays and is now rarely used. ---