Headache Flashcards
What is the clinical presentation of a tension headache?
30min- 1 hour Headband pain Bilateral Does not interfere with life No nausea or vomiting Phono or photophobia but not both
What is the mechanism for a tension headache?
Muscle contraction compresses the occipital nerve
Emotional stress
What is a cluster headache?
Some pain behind the eyes
What is the pathophysiology of cluster headaches?
Hypothalamic activation of trigeminovascular autonomic system and parasympathetics
Cause by genetics?
What is the clinical presentation of a cluster headache?
Unilateral
Orbital
Circadian periodicity
Nasal, lacrimal ion
What is the treatment for a cluster headache?
Oxygen
Sumatriptan and zolmitriptan
What gender is cluster headache more common?
Male 4:1
What gender are migraines more common?
Female 3:1
What is the clinical key to a migraine?
Debilitating
Have to stop doing stuff
Throbbing and pulsing
What is the theory for why migraines happen?
Typically unilateral Possibly spreading cortical depression Genetic Possible neurotransmitter dysfunction Possible dorsal pontine activation
What causes an increased risk of stroke with patients that have a migraine with an aura?
Oral contraceptives like sildenafil
What is the management of migraines?
Triptans and DHE
How do you prevent migraines?
Amitriptyline
Divalproex
Propranolol
Timolol
What are the two actions of triptans?
Vasoconstriction by 5-HT1 b and d
Decreased pro-inflammatory neuropeptide CGRP
