She lost her consciousness. CT=normal. Neurological exam=normal. What is the most
appropriate management?
a. Repeat CT
b. MRI
c. LP
d. XR
e. No inv required
E
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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