Headache 2 Flashcards
What is a migraine?
Repeated attacks of hemicranial headaches
Usually have triggers
Visual vertigo
Easily hungover
Motion sickness
What are the three forms which make up a migraine?
Pain
Pain + focal symptoms
Focal symptoms
What phases of migraine is there? (5)
- Prodome
- Aura
- Headache
- Resolution
- Recovery
lasts for 48 hours
What is prodome?
Changes in mood, urination, fluid retention, food craving, yawning
What is an Aura?
Visual / sensory numbness/paraesthesia, weakness and or speech arrest
What is a negative aura?
Blackness, loss of vision
What are positive aura symtoms?
flashes, zigzags, bright starbursts
- when positive and negative come together this is very characteristic of a migraine
What may px say about their aura?
Expanding Cs
Elemental visual disturbance - can see expansion of image to periphery
How do you treat an acute attack of migraine?
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
Why is it good to give to give soluble preparations of medication for migraine?
Sickness and GI effects can be an issue to take drug
Why is it recommended to take painkillers straight away as migraine is noticed?
Take as soon as it comes on as once it starts taking meds will not help to ease symptoms as much
How can TMS be used to treat migraines?
Interrupts the complex network that triggers migraine - as migraines are caused by spreading electrical depression across cerebral cortex
How to treat migraines with lifestyle changes?
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
What is chronic migraines?
More than 14 a month
What is Migraine prophylaxis?
When migraines are chronic and cannot give painkillers all the time
What is a tension type headache?
Tight muscles around head and neck bilaterally as though head is in a vice
What over the counter preparations can be used for headache control?
feverfew, coenzyme Q10, riboflavin, magnesium, EPO, nicotinamide
How are beta blockers used for migraines?
Propranol Atenolol
Prevents headache but also lowers BP and pulse
People with asthma cannot take beta blockers
How are calcium channel blockers used?
Flunarazine and verapamil very effective
good for migraine
What is Erenumab used for?
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
What else can be used to help migraines?
- 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
What is a typical cluster headache?
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
what are the signs and symptoms of cluster headache?
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
Where is the site of pain for cluster headache primarily?
1 - Eye
2 - Forehead
3 - Temple
4 - Cheek
What is the acute treatment for cluster headache?
Inhaled oxygen. Oxygen inhibits neuronal activation in the trigeminocervical complex
S/C or Nasal Sumatriptan
What is the prevention drugs for cluster headaches?
Verapamil Prednisolone Lithium Valproate Gabapentin Topiramate Pizotifen
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
What are the three most common primary headaches?
Migraine
Cluster
Tension
Primary headache = problem not symptom
