NURS 6501: Week 7 Quiz:
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Question 4
A 30-year old female presents to the clinic with a history of recurrent, throbbing headaches that occur on one side of her head. These headaches are often preceded by visual disturbances, such as seeing flashing lights or blind spots. During an attack, she experiences nausea, vomiting, and sensitivity to light and sound. She has identified certain triggers, including stress and lack of sleep. Her family history is significant for migraines.
Which of the following best explains the pathophysiological mechanism underlying her migraine attacks?
Group of answer choices
- Compression of cranial nerves by a brain tumor
- Spreading cortical depression and cortical spreading activation
- Chronic hypertension leading to cerebral ischemia
- Autoimmune-mediated demyelination of CNS neurons
Correct answer:
Spreading cortical depression and cortical spreading activation
Explanation:
This patient presents with a classic case of migraine with aura:
- Unilateral throbbing headache
- Visual aura (flashing lights, blind spots)
- Nausea, vomiting
- Photophobia and phonophobia
- Triggered by stress, sleep disturbance, etc.
- Positive family history (migraines often run in families)
Pathophysiology of migraine (especially with aura):
- Involves a phenomenon called cortical spreading depression (CSD):
- A wave of neuronal and glial depolarization that slowly propagates across the cerebral cortex.
- This leads to transient disruption in brain activity, causing aura symptoms.
- Followed by activation of the trigeminovascular system, resulting in inflammation, vasodilation, and pain.
Cortical spreading depression = initial hyperactivity, then neuronal suppression, triggering migraine pain.
Why the other options are incorrect:
- Compression of cranial nerves by a brain tumor
→ Would present with progressive neurological deficits, not episodic migraine-like symptoms. - Chronic hypertension leading to cerebral ischemia
→ Causes vascular damage or stroke, not episodic migraines with aura. - Autoimmune-mediated demyelination of CNS neurons
→ Seen in multiple sclerosis, which can sometimes cause headaches, but doesn’t match this classic migraine pattern.
