Headache Flashcards
What are the pain-sensitive structures that can cause headaches?
dura, dural venous sinus, falx cerebri, middle meningeal artery, circle of Willis, anterior meningeal artery, scalp, CN-5, 9, 10, and proximal segment of pial arteries.
the pain-insensitive structures that do not cause headaches
pial veins, choroid plexus, cerebral parenchyma, and ependyma
difference between primary and secondary headaches?
Primary headaches have no organic or structural cause and are often benign and recurrent, while secondary headaches have a structural or organic cause present.
most consistent finding in increased intracranial pressure?
papilledema
recommended treatment for acute attacks of tension type headache?
Small dose NSAID’s.
recommended long-term treatment for tension type headache?
Amitriptyline or TCA.
the different patterns of aura in classical migraine?
Visual (more common), auditory, or abdominal aura.
most common pattern of aura in classical migraine?
Zig zag pattern on visual field.
other patterns of aura in migraine?
Fortification spectra like a rainbow, Scintillating scotomas.
associated symptoms of migraine?
photophobia, phonophobia, nausea with or without vomiting.
patient’s preference during a migraine attack? And duration
to be in a quiet, dark room. 4-72 hours
most important cytokine linked with migraine headaches?
calcitonin gene related peptide.
pathogenesis of migraine headaches according to the vascular theory?
Aura is due to vasoconstriction, following which there is a vasodilatation which causes headache.
pathogenesis of migraine headaches according to the serotonin theory?
Increased serotonin levels are linked with migraine headaches.
the epicenter of pain in migraine headaches?
The epicenter of pain is the trigeminovascular complex.
What is ophthalmoplegic migraine?
Ophthalmoplegic migraine is a migraine with transient unilateral 3rd nerve palsy
What is basilar type migraine?
Basilar type migraine is a migraine with transient posterior circulation symptoms.
the treatment for mild attacks, mild to moderate, DOC for moderate to severe of migraine?
Paracetamol
NSAIDs (Naproxen - 550mg or Ibuprofen - 400mg).
Triptans
mechanism of action of triptans?
5HT 1B/1D agonist causing vasoconstriction.
intranasal triptan used for treating migraine?
Zolmitriptan, sumatriptan.
treatment for very severe attacks of migraine?
6mg subcutaneous sumatriptan
What is given along with triptans to treat vomiting?
Dopamine antagonists (Metoclopramide).
the issues with triptans?
Clinical efficacy depends on T max,
ineffective in migraine with aura,
contraindicated in patients with cardiovascular or cerebrovascular disease.
the first-line drug for prophylaxis of migraines?
Propranolol or TCA or Topiramate.
mechanism of action of Flunarizine?
It is a selective sodium channel blocker.
contraindication for Ergotamine?
Patients with cardiovascular or cerebrovascular disease.
monoclonal antibody against CGRP?
Erenumab
example of Trigeminal Autonomic Cephalgia?
Cluster headache
drug of choice for patients with cardiovascular or cerebrovascular disease?
Dihydro-ergotamine.
second-line drug for prophylaxis of migraines?
Telmisartan or venlafaxine or valproate.
What is the preferred treatment for Hemicrania Continua?
Indomethacin
