19 - Headache + Migrane

Question 1

Difference between a primary and secondary headache

Answer 1

Primary - Diagnosis without physical signs

Secondary - Diagnosis with physical signs

Question 2

Percentage of headaches that are tension-type

Answer 2

80%

Question 3

What do tension type headaches feel like

Answer 3

Band like, bilateral, tightness, pressure, dull ache

Radiate to neck and shoulders - mild to moderate

Question 4

How do you treat a tension type headache

Answer 4

Analgesics

Question 5

Percentage headaches that are cluster headaches

Answer 5

0.2 - 0.3%

Question 6

Features of a cluster headache

Answer 6

Severe pain on one side of the head
Triggered by sleep
More common in men

Question 7

Treatment of cluster headache

Answer 7

High flow oxygen - vasoconstriction

Highly caffinated drinks

Question 8

Percent that are migraines

Answer 8

15%

Question 9

Features of migraine

Answer 9

need 2/3

Light bothers you, headache limits ability to work, feel nauseated/sick

Question 10

What do you inherit in genetics of migraine

Answer 10

Inherit over responsive brain

Heightened senses to smell, light, sounds and touch

Question 11

Migraine triggers

Answer 11

Hormones
Lack of food
Lack of sleep
Dehydration

Question 12

% migraines without aura

Answer 12

70-80%

Question 13

% migraines with aura

Answer 13

20-30%

Question 14

When does the migraine start

Answer 14

Usually 48hours before the headache starts

Question 15

What happens to 5HT levels during a migraine

Answer 15

They increase

Question 16

What happens if you deplete serotonin

Answer 16

It can trigger a migraine

Serotonin infusions - can relieve a migraine

Question 17

Acute drug class for migraine

Answer 17

Triptans

Question 18

Prophylactic drug for migraine

Answer 18

Methysergide

Question 19

5 stages of Migraine

Answer 19

Premonitory 
Aura
Headache
Resolution
Recovery

Question 20

Premonitory Symptoms

Answer 20

Food craving
Neck pain
Fluid retention

Question 21

What is an aura

Answer 21

Visual and/or sensory and/or speech and language problems

Question 22

How long does and aura last

Answer 22

20/30 mins - 1hour

Question 23

What causes an aura

Answer 23

Cortical Spreading Depression

Question 24

Features of headache phase

Answer 24

Poor concentration
malaise
lethargy
heightened sense of smell

Question 25

What pathway does headache go through

Answer 25

Trigeminovascular pathways

Question 26

What happens in headache pathway

Answer 26

Inflammatory neuropeptides such as CGRP are released
These activate the nerve pathway
Pain signals are sent to the trigeminal ganglion
Trigeminal nerve transmits pain impulses to trigeminal nucleus caudalis
Pain impulses to thalamus –> Cerebral Cortex

Question 27

What mediates throbbing pain

Answer 27

Peripheral sensitisation

Question 28

Role of CGRP

Answer 28

Vasodilator

Levels RISE in migraines

Question 29

MoA of triptans

Answer 29

5HT1D/B agonists

Question 30

Examples of triptans

Answer 30

Zolmatriptan
Naratriptan
Eletriptan

Question 31

CGRP monoclonal antibodies

Answer 31

Used for prevention

Fremanezumab