Headache 24-01: Headache Flashcards
What is the pathophysiology of migraine
- Relates to neuronal dysfunction in the trigeminal system resulting in release of vasoactive neuropeptides
What are the clinical findings of a typical migraine us headache
- Lateralize throbbing headache that occurs episodically
*associated with Anorexia, nausea, vomiting, photophobia, phonophobia, osmophobia, cognitive impairment, blurring of vision
What are scotoma
Visual disturbances that occur and consists of feild defects
What is photopsia
Luminous visual hallucinations such a as stars, sparks, unformed light flashes
What is migraine aura without headache
Neurologic or somatic disturbance accompanying typical migraines headaches that becomes the sole manifestation of an attack
What is migraine with brain stem aura
Where blindness or visual disturbances throughout both visual fields are accompanied or followed by dysarthria, disequilibrium, tinnitus and are sometimes followed by transient loss or impairment of consciousness
What is recurrent painful ophthalmoplegic neuropathy
Eye
1. N/V
2. Diplopia
*due to transient external ophthalmoplegia (due to third nerve palsy, with accompanying sixth nerve involvement)
What should simple analgesics be limited to when used for migraine treatment?
15 days or less per month
What are the different types of treatment options for migraines?
- Ergotamines
*avoid during pregnancy, patients with cardiovascular disease, patients taking CYP - Serotonin agonists
*Sumatriptan will abort attacks, give subcutaneously
*nasal and oral preparations are available but may be less effective due to slower absorption
*eletriptan is useful for immediate therapy
*frovatriptan is useful for prolonged attacks or attacks provoked by menstrual periods
What are the different types of treatment options for migraines? (Cont)
- Calcitonin gene-related peptide antagonists
*rimegepant
*ubrogepant - Other
*prochlorperazine (rectal, IV, IM)
*metoclopramide
When would preventive treatment be needed?
- If migraine headaches occur more frequently than two or three times a month
*use a diary
*acupuncture is as effective as prophylactic pharmacological treatment
What is the MC type of primary headache disroder
Tension-type headache
What will a patient with a tension type headache complain about
- Pericranial tenderness
- Poor concentration
- Tight in quality but not pulsatile
- Generalized
*back of neck or back of head
Are Tristan’s and erotamines indicated for tension-type HA
No
What can be used as prophylaxis for tension-type HA
Amitriptyline
What is a cluster HA related to?
Activation of cells in the ipsilateral hypothalamus
*triggering autonomic vascular system
How do patients present with a cluster HA
- Restless and agitated
- Episodes typically occur at night, awake the patient
- Spontaneous remission occurs
What do the trigeminal autonomic cephalgias consist of?
- Unilateral periorbital pain
- Ipsilateral autonomic symptoms
*will respond to indomethacin
What is used to treat a cluster Ha
Subcutaneous or inhaled medication
*sumatripatan, zolmitriptan
*oral medications is unsatisfactory
What are prophylactic agents
- Lithium carbonate
- Verapamil
- Topiramate
- Prednisone
- Ergotamine (rectal or subcutaneous)
What are the features of a post traumatic HA
- Constant dull ache
- Superimposed throbbing
- Localized, lateralized or generalized
How long does a primary cough HA last for?
- A few minutes or less
*self-limited
*indomethacin may provide relief
How will a HA due to intracranial mass lesion present
- Worse upon lying down
- Awaken the patient at night or morning
What is the key feature to prompt brain imaging
New or worsening Ha in middle or later life
