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Neurology and Neuroscience > Headache 2 > Flashcards

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
Q

What is the acute treatment for cluster headache?

A

Inhaled oxygen. Oxygen inhibits neuronal activation in the trigeminocervical complex

S/C or Nasal Sumatriptan

26
Q

What is the prevention drugs for cluster headaches?

A 
Verapamil
Prednisolone 
Lithium 
Valproate
Gabapentin
Topiramate
Pizotifen
27
Q

What are the differences between migraine vs cluster

A

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
Q

What are the three most common primary headaches?

A

Migraine
Cluster
Tension

Primary headache = problem not symptom

Neurology and Neuroscience (21 decks)

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