29 HA Flashcards
Primary headaches?
tension, migraine, and cluster
Primary headaches are typically (acute/subacute)
subacute
All headaches cause:
inflammation or physical traction of pain sensitive structures within or around the cranial vault
Pain sensitive structures:
- dura and meninges at base of brain
- large arteries at base of brain and meningeal arteries
- venous sinuses
- scalp muscles + upper cerv muscles
- periosteum of skull
Stimulation of cranial pain receptors is transmitted centrally largely through:
CN V, IX, and cervical roots C2-3
~VII, X
Innervates pain sensitive structures of the ant/middle fossa and scalp.
opth branch of V
Innervates pain from posterior fossa, cervical muscles, neck and post scalp.
CN IX, X and cervical roots C2-3
Where do pain sensitive nerve fibers synapse?
trigeminal nucleus caudalis + dorsal horn of the upper cervical spine
Centrally projecting nerve fibers synapse in:
They are then relayed on to:
VPL and VPM nuclei of the thalamus
sensory cortex and other cortical sensory systems.
Red flags suggesting secondary etiology for HA:
abrupt onset recent head trauma fever immunosuppression new onset >50yo progression over days
Migraine prodrome symptoms:
odd food cravings mood swings malaise fatigue muscle aches/stiffness
Location of one known loci for polygenic migraines.
10q23
Dominant migraine condition:
Familial Hemiplegic Migraine
Migraine onset MC =
<20
decr occurrence after 55
Anatomical substrate for all migraines:
Trigeminovascular System (CN V1)
*innervates pain R’s in dura, meninges, and medium/large cerebral arteries/veins on surface of brain + above tentorium
What causes parasymp symptoms associated with migraines?
VII and parasymp innervation of superior salivary nucleus –> central connections between pain pathways from CN V and the superior salivatory nucleus