Ch 11 - Pain Medicine: Headache Flashcards
What are types of primary HA?
Migraine Headache
Tension Headache
Cluster Headache
What is a secondary HA?
symptom of an underlying disease or organic process
What is the presentation of migraine HA?
Unilateral > bilateral, pulsing/throbbing, stabbing, frontal, or temporal pain.
Can occur with or without aura
What are associated symptoms of migraine HA?
nausea, vomiting, photophobia, phonophobia, vertigo, diarrhea, or diaphoresis
What is status migrainosus?
Intractable migraine up to 1 week
What are symptoms of focal auras?
Visual disturbances (bright spots, dark spots, tunnel vision), tremor, pallor, vertigo, unilateral numbness or weakness, transient aphasia, or thick speech that precedes the HA
What are resolution or premonitory symptoms of migraine HA?
Hyperactivity, hypoactivity, depression, craving
for particular foods, repetitive yawning
What is the Cortical spreading depression (CSD) theory of migraine HA?
wave of neuronal
depolarization in the cortical gray matter followed by neuronal activity suppression, resulting in
blood flow changes
What is the Neurovascular theory of migraine HA?
Peptide NT vasodilate nearby blood vessels→ extravasation of plasma→ stimulates the trigeminal nerve endings→ nociceptive orthodromic activation to the trigeminal ganglion→pain
What is the vascular theory of migraine HA?
Intracranial vasoconstriction→aura
Subsequent rebound vasodilation and activation of perivascular nociceptors→HA
What are abortive medications for migraine HA?
- Acetaminophen
- NSAIDs (e.g., aspirin, ibuprofen, naproxen, ketorolac)
- Opioids (butalbital, meperidine)
- Adjunctive medications (prochlorperazine and metoclopramide)
- Ergotamines (FDA pregnancy category X)
- Triptans (5-HT 1B and 1D agonists)
What are preventive medications for migraine HA?
- Beta-blockers (e.g., propranalol, timolol)
- NSAIDs
- TCAs (e.g., amitriptyline)
- SSRIs (e.g., fluoxetine)
- Antiepileptics (valproic acid, carbamazepine, gabapentin)
- Magnesium
- Botulinum toxin injections
What is the MC type of HA?
Tension-type HA
What is the presentation of tension-type HA?
Mild-moderate, bilateral “tight band” or pressure pain around the head
What is the tx for tension-type HA?
Over-the-counter (OTC) analgesics (aspirin, acetaminophen, or ibuprofen)
What is the presentation of cluster HA?
Episodic, severe, stabbing, unilateral, periorbital/temporal HA pain. Periorbital pain affecting the distribution of the first trigeminal nerve (temple, forehead, cheek)
What are associated symptoms of cluster HA?
miosis, ptosis, conjunctival injection, lacrimation, and rhinorrhea
Who is MC affected by cluster HA?
20-40 yo
predominantly affects males
What is Hemicrania continua?
Similar symptoms as cluster HA, but responds to indomethacin
What are ppx tx for cluster HA?
Verapamil, methysergide, steroids, ergotamine, DHE, lithium, and antiepileptics
What are abortive tx for cluster HA?
100% oxygen (7 to 12 L), sumatriptan, dihydroergotamine (DHE), intranasal lidocaine 4% to 6%
