Headache

Question 1

headache classification

Answer 1

primary:

• migraine
• tension
• cluster/ V-autonomous cephalgias
• other

secondary:

• trauma
• vascular disorders
• non-vascular intracranial disorders
• substances or withdrawal
• infection
• homeostasis disorders
• psychiatric disorders

Question 2

Which are the 4 phases of migraine?

Answer 2

• prodrome: occurs in 60%, euphoria, depression, irritability, food craving, constipation, incr. yawning
• aura: occurs in 20%, visual manifestations, develops over 5mins. sometimes aura without headaches
• headache: often unilateral, in 40% it is bilateral
  throbbing and pulsatile, increased severity over hours, accompanied by nausea and vomiting, photophobia, phonophobia, can stay for h - d
• postdrome: sudden head movements cause pain, exhausted and drained feeling

Question 3

Treatment of migraine

Answer 3

abortive:
- NSAIDS (mild-mod)
- acetaminophen
- triptan (mod-severe headache)
- antiemetics

preventive:

• bBlockers: propanolol, metoprolol, atenolol
• CCB: diltazem, verapamil, amlodipine
• antidepressants: amitryptiline, sertaline, fluxetine
• antiepilectics: valporate, gabapentin

Question 4

Clincial aspect of cluster headaches

Answer 4

belongs to V-autonomous cephalgias (unilat. severe headache), affects more males

severe orbital, suborbital, temporal pain
autonomous phenomena (ptosis, miosis, lacrimation rhinorhea),
restlessness, agitation
is only unilateral, short lived and occur up to 8x/d, daily for some weeks
prefered forward-backward tangling while sitting

Question 5

Treatment for cluster headaches

Answer 5

abortive:

• O2: 12L/min for 15 mins
• triptans: sumatripan, rizatriptan

preventive:

• verapamil 240 - 360 mg/d
• glucocorticoids, lithium, topiramate, methylsergide

Question 6

clinical aspect of tension headache

Answer 6

most common type of headaches, F>M

mild-moderate intensity, non-throbbing

Question 7

Treatment of tension headache

Answer 7

acute:
acetaminophen
aspirin
ibuprofen
naproxen
ketoprofen
diclofenac
caffeine

preventive:
amitryptiline
metrazapine
venlafaxine
clomipramine

Question 8

clinical aspect of trigeminal neuralgia

Answer 8

is one of the most common causes of facial pain
unilateral intense, sharp, stabbing pain
lasts for few seconds
frequently in patiens >50yoa.
if assoc. with VII nerve muscle spasms = tic douloreux

Question 9

classification of trigeminal neuralgia

Answer 9

classical neuralgia: caused by neurovasc. compression

painful neuropathy:
causes: acute herpes zoster, post herpetic, posttraumtic, MS plaque, other disorders

Question 10

treatment of trigeminal neuralgia

Answer 10

carbamezapine
oxcarbazepine
lamotrigine
gabapentin
tricyclic antidepressants