consciousness. She is brought to the hospital where she is found to be conscious and completely
alert. Exam: normal pulse & BP. No abnormal neurological signs. What is the next step in
management?
a. Admission for observation
b. CT brain
c. MRI head
d. Reassurance and discharge
e. XR skull
answer: D
diagnosis: basilar migraine ... ttt/reassurance, avoid triggers
Migraine
• stages of
uncomplicated migraine
i. prodrome (hours to days
before headache onset)
ii. aura
iii. headache (see Table
24 for description of typical headache)
iv. postdrome
• aura
fully reversible symptom of focal cerebral dysfunction
lasting <60 min
examples: visual disturbance (fortification spectra –
zigzags; scintillating scotomata – spots), unilateral paresthesia and numbness
or weakness, aphasia
• prodrome/postdrome:
appetite change, autonomic symptoms, altered mood, psychomotor agitation/retardation
• classification
of migraines
1. common
migraine: no aura
2. classic
migraine: with aura (headache follows reversible aura within 60 min)
3. complicated
migraine: with severe/persistent sensorimotor deficits, examples:
-
basilar-type migraine (occipital headache with
diplopia, vertigo, ataxia, and altered
-
level of consciousness)
-
hemiplegic/hemisensory migraine
-
ophthalmoplegic migraine
-
acephalgic migraine (i.e. migraine equivalent):
aura without headache
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