Common Headache Disorders - Ferguson Flashcards
scalp sinuses meninges pial arteries arteries and major veins midbrain are these sensitive to pain
yes
ventricles choroid brain parenchyma (except midbrain) small parenchymal and dural veins sensitive to pain
no
What specific area of the brainstem is known to cause headaches
- midbrain
- dorsal raphe nucleus
- high concentration of serotonin
What causes migranes
- brainstem: abnormal instability or activation of certain cells which spread peripherally and stimulate the
- trigeminal nerve
- chemoreceptors
- autonomic nervous system
what type of headache am i? unilateral headache deep ache or throbbing sensation phonophobia, photophobia, and/or nausea vomiting worsen with exertion relieved by rest
migraine without aura
what is aura
perceptual distrubace experienced prior to headache onset with can manifest as visual disturbance sensory disturbance motor disturbance auditory disturbance
what is complicated migraine
same as migraine with aura but aura is quite dramatic and can last longer
complicated migraines can mimic what
stroke
basilar migraine is associated with what part of the brain
brainstem
posterior cerebral circulation
what are common symptoms of basilar migraine
vertigo
dysathra
ataxia
diplopia
what is the most severe form of basilar migraine
Bickerstaff’s migraine
what are clinical symptoms of Bickerstaff’s migraine
total blindness followed by vertigo, ataxia, dysarthria and/or tinnitus
For Basilar migraine, compare the onset of headache and neurological symptoms onset
headache onset follows 20-30 min following neurologic symptom onset
describe the pain and location for basilar migraine
occipital throbbing pain
what are types of drugs used for abortive or rescue therapy for migraines
NSAIDS
5HT1
dopamine antagonists
combinations
what 5HT1 agonists are available orally
Triptans
Ergots
what 5HT1 agonists are inhaled or comes in a subcutaneous form
Sumatriptan
Zolmitriptan
Frovatriptan
When should prophylactic therapies be used for migraines
severe enough to cause functional impairment
OCCRUS 3 TIMES PER MONTH
What type of drug is used for prophylactic use of migraines ? Specific categories?
Beta- adrenergic blockers
- calcium channel blockers
- Tricyclic antidepressants
- anticonvulsants
- serotonergic durgs
Propranolol
Atenolol
Beta adrenergic blockers
Verapamil
Calcium channel blockers
Amitriptyline
Nortriptyline
Tricyclic antidepressants
Gabapentin
Valproic acid
Topiramate
Levetiracetam
Anticonvulsants
Cyproheptadine
Serotonergic drugs
define cluster headache
episodic headache: 1-3 short duration (15-30 min in length)
- severe unilateral stabbing periorbital or temporal pain
- 3-6 weeks
what are some associated symptoms for cluster headache
conjunctival injection/lacrimation miosis ptosis eyelid edema rhinorrhea/nasal congestion perspiration remarkable circadian rhythm
Where in the brain do cluster headaches derive from
hypothalamus: prominent autonomic symptoms
secondary activation of trigeminal-autonomic reflex via trigeminal-hypothalamic pathway
what are 2 acute treatment options for cluster headaches? which one is more effective
oxygen: high concentration for 15 minutes, MOST EFFECTIVE ABORTIVE AGENT, if pain is still present prescribe–>
Triptans
when should prophylactics be used for cluster headaches
should only be started at onset of cluster
What are two prophylactic options for cluster headaches
high dose steroids
calcium channel blockers
what is the most prevalent headache syndrome
tension headache
what do tension headaches feel like
squeezing or pressure around the head
What are symptoms that are never associated with tension headaches
NAUSEA OR VOMITING
what are non-pharmacologic treatment options for tension headaches
stress reduction
biofeedback
cognitive behavioral therapy
improved sleep hygiene
what are abortive treatment options for tension headaches
acetaminophen
NSAIDS
what are two prophylaxis treatment options for tension headaches
tricyclic antidepressants
antiepileptic: Gabapentin
Idiopathic intracranial hypertension IIH is a disturbance that causes what
increased intracranial pressure without evidence of an intracranial mass, hydrocephalus or dural venous stenosis
Idiopathic intracranial hypertension is usually seen in what patients? what can create this problem
young obese females
and if they take tetracylcines, oral contraceptive pills, hypervitaminosis A
describe the symptoms of idiopathic intracranial hypertension
new onset continuous daily headache that worsens with cough, sneezing, and moving into the supine position
what is the initial work up of idiopathic intracranial hypertension
MRI, find nothing then
LP: done in lateral decubitus position in order to obtain accurate opening pressure
ophthalmologic exam
what is the non-pharmacologic treatment for idiopathic intracranial hypertension
weight loss
what are medical treatment options for diopathic intracranial hypertension
removal of offending drugs
use drugs that decrease CSF production
name 2 drugs that decrease CSF production
Acetazolamide
Topiramate
what are the 2 secondary headache disorders
idiopathic intracranial hypertension
Giant cell arteritis
symptoms of Giant cell Arteritis
- unilateral throbbing headache in temporal scalp
- complain of concomitant jaw claudication, diffuse joint pains, visual disturbances, and transient monocular vision loss
- seen in 50 yrs or greater
what is the gold standard for making the diagnosis for giant cell arteritis
temporal artery biopsy
treatment for Giant cell arteritis
Steroids
what is the diagnostic criteria for common migraine
at least 5 attacks fulfilling the following:
- lasts 4-72 hours
- unilateral, pulsating, debilating
- nausea or photophobia
what makes classic migraine different from common migraine
presence of an aura
