Ch 11 - Pain Medicine: Headache

Question 1

What are types of primary HA?

Answer 1

Migraine Headache
Tension Headache
Cluster Headache

Question 2

What is a secondary HA?

Answer 2

symptom of an underlying disease or organic process

Question 3

What is the presentation of migraine HA?

Answer 3

Unilateral > bilateral, pulsing/throbbing, stabbing, frontal, or temporal pain.
Can occur with or without aura

Question 4

What are associated symptoms of migraine HA?

Answer 4

nausea, vomiting, photophobia, phonophobia, vertigo, diarrhea, or diaphoresis

Question 5

What is status migrainosus?

Answer 5

Intractable migraine up to 1 week

Question 6

What are symptoms of focal auras?

Answer 6

Visual disturbances (bright spots, dark spots, tunnel vision), tremor, pallor, vertigo, unilateral numbness or weakness, transient aphasia, or thick speech that precedes the HA

Question 7

What are resolution or premonitory symptoms of migraine HA?

Answer 7

Hyperactivity, hypoactivity, depression, craving

for particular foods, repetitive yawning

Question 8

What is the Cortical spreading depression (CSD) theory of migraine HA?

Answer 8

wave of neuronal
depolarization in the cortical gray matter followed by neuronal activity suppression, resulting in
blood flow changes

Question 9

What is the Neurovascular theory of migraine HA?

Answer 9

Peptide NT vasodilate nearby blood vessels→ extravasation of plasma→ stimulates the trigeminal nerve endings→ nociceptive orthodromic activation to the trigeminal ganglion→pain

Question 10

What is the vascular theory of migraine HA?

Answer 10

Intracranial vasoconstriction→aura

Subsequent rebound vasodilation and activation of perivascular nociceptors→HA

Question 11

What are abortive medications for migraine HA?

Answer 11

1. Acetaminophen
2. NSAIDs (e.g., aspirin, ibuprofen, naproxen, ketorolac)
3. Opioids (butalbital, meperidine)
4. Adjunctive medications (prochlorperazine and metoclopramide)
5. Ergotamines (FDA pregnancy category X)
6. Triptans (5-HT 1B and 1D agonists)

Question 12

What are preventive medications for migraine HA?

Answer 12

1. Beta-blockers (e.g., propranalol, timolol)
2. NSAIDs
3. TCAs (e.g., amitriptyline)
4. SSRIs (e.g., fluoxetine)
5. Antiepileptics (valproic acid, carbamazepine, gabapentin)
6. Magnesium
7. Botulinum toxin injections

Question 13

What is the MC type of HA?

Answer 13

Tension-type HA

Question 14

What is the presentation of tension-type HA?

Answer 14

Mild-moderate, bilateral “tight band” or pressure pain around the head

Question 15

What is the tx for tension-type HA?

Answer 15

Over-the-counter (OTC) analgesics (aspirin, acetaminophen, or ibuprofen)

Question 16

What is the presentation of cluster HA?

Answer 16

Episodic, severe, stabbing, unilateral, periorbital/temporal HA pain. Periorbital pain affecting the distribution of the first trigeminal nerve (temple, forehead, cheek)

Question 17

What are associated symptoms of cluster HA?

Answer 17

miosis, ptosis, conjunctival injection, lacrimation, and rhinorrhea

Question 18

Who is MC affected by cluster HA?

Answer 18

20-40 yo

predominantly affects males

Question 19

What is Hemicrania continua?

Answer 19

Similar symptoms as cluster HA, but responds to indomethacin

Question 20

What are ppx tx for cluster HA?

Answer 20

Verapamil, methysergide, steroids, ergotamine, DHE, lithium, and antiepileptics

Question 21

What are abortive tx for cluster HA?

Answer 21

100% oxygen (7 to 12 L), sumatriptan, dihydroergotamine (DHE), intranasal lidocaine 4% to 6%