Headache 2 Flashcards

1
Q

What is a migraine?

A

Repeated attacks of hemicranial headaches

Usually have triggers

Visual vertigo

Easily hungover

Motion sickness

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2
Q

What are the three forms which make up a migraine?

A

Pain
Pain + focal symptoms
Focal symptoms

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3
Q

What phases of migraine is there? (5)

A
  • Prodome
  • Aura
  • Headache
  • Resolution
  • Recovery

lasts for 48 hours

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4
Q

What is prodome?

A

Changes in mood, urination, fluid retention, food craving, yawning

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5
Q

What is an Aura?

A

Visual / sensory numbness/paraesthesia, weakness and or speech arrest

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6
Q

What is a negative aura?

A

Blackness, loss of vision

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7
Q

What are positive aura symtoms?

A

flashes, zigzags, bright starbursts

  • when positive and negative come together this is very characteristic of a migraine
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8
Q

What may px say about their aura?

A

Expanding Cs

Elemental visual disturbance - can see expansion of image to periphery

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9
Q

How do you treat an acute attack of migraine?

A

Aspirin/Ibuprofen and paracetamol and metoclopramide (anti-emetic to stop nausea to get drug down )

Triptans tablets, melts, nasal sprays : vasoconstrictors which synergise with NSAIDS so take together

Can give opiates with caution

A short nap

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10
Q

Why is it good to give to give soluble preparations of medication for migraine?

A

Sickness and GI effects can be an issue to take drug

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11
Q

Why is it recommended to take painkillers straight away as migraine is noticed?

A

Take as soon as it comes on as once it starts taking meds will not help to ease symptoms as much

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12
Q

How can TMS be used to treat migraines?

A

Interrupts the complex network that triggers migraine - as migraines are caused by spreading electrical depression across cerebral cortex

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13
Q

How to treat migraines with lifestyle changes?

A

There are genetic factors which cause sensitivity and the environment can trigger a migraine

Figure out trigger e.g. dietary, hormonal, weather, stress,

Drink 2 L water
Avoid caffeine
Don't skip meals
Don't oversleep 
Analgesic abuse
Alcohol
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14
Q

What is chronic migraines?

A

More than 14 a month

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15
Q

What is Migraine prophylaxis?

A

When migraines are chronic and cannot give painkillers all the time

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16
Q

What is a tension type headache?

A

Tight muscles around head and neck bilaterally as though head is in a vice

17
Q

What over the counter preparations can be used for headache control?

A

feverfew, coenzyme Q10, riboflavin, magnesium, EPO, nicotinamide

18
Q

How are beta blockers used for migraines?

A

Propranol Atenolol

Prevents headache but also lowers BP and pulse

People with asthma cannot take beta blockers

19
Q

How are calcium channel blockers used?

A

Flunarazine and verapamil very effective

good for migraine

20
Q

What is Erenumab used for?

A

Injectable drug

cut numbers of migraine from 8 a month to 4-5 a month

Monoclonal antibody: disables calcitonin gene-related peptide of its receptor

For Episodic migraine for chronic or cluster headache

21
Q

What else can be used to help migraines?

A
  • Anticonvulsants: valproate, topiramate, gabapentin
  • Greater occipital nerve blocks
  • Botox: crown of thorns
  • Suppress ovulation (progesterone only pill or implant/injection) - for women who get triggered by hormones, no oestrogen as that causes the headache
22
Q

What is a typical cluster headache?

A

Severe unilateral pain lasting 15-180 minutes untreated.
Classified as a trigeminal autonomic cephalgia.

At least one of the following, ipsilaterally:
Conjunctival redness and/or lacrimation
Nasal congestion and/or rhinorrhoea
Eyelid oedema

23
Q

what are the signs and symptoms of cluster headache?

A

Forehead and facial sweating

Miosis and/or ptosis

A sense of restlessness or agitation

Frequency between one on alternate days to 8 per day.

Not associated with a brain lesion on MRI

24
Q

Where is the site of pain for cluster headache primarily?

A

1 - Eye
2 - Forehead
3 - Temple
4 - Cheek

25
What is the acute treatment for cluster headache?
Inhaled oxygen. Oxygen inhibits neuronal activation in the trigeminocervical complex S/C or Nasal Sumatriptan
26
What is the prevention drugs for cluster headaches?
``` Verapamil Prednisolone Lithium Valproate Gabapentin Topiramate Pizotifen ```
27
What are the differences between migraine vs cluster
Migraine vs cluster - 3-12 hours vs 45min-3 hours - 1-8 month. vs 1-3 daily Nausea and vomiting vs rarely pulsing hemicranial pain vs steady unilateral Auras vs autonomic features Px lie in the dark vs px pace about
28
What are the three most common primary headaches?
Migraine Cluster Tension Primary headache = problem not symptom