Headache Flashcards
What are the criteria for tension type headache?
Two of the following: Bilateral, pressing/tightening, mild-mod pain, not worsened by physical activity.
Both of the following: no nausea/vomiting, not BOTH photo and phonophobia.
what is the theoretical migraine pathway in the brain?
- activation of central generator (brainstem or cortex)
- disrupted ion hemeostasis, neuron dysfunction
- meningeal blood vessel dilation, activation of trigeminovascular system
- release of vasoactive neuropeptides, sterile inflammation.
- worsening vasodilation, firing of trigeminal afferents.
in what patients are triptans contraindicated?
any cardiovascular risk factors.
what is the receptor target for triptans and what is the result?
5-HT1B- agonism results in constriction of meningeal blood vessels.
5-HT1D- agonism presynaptically inhibits peptide release and interferes with trigeminal nucleus caudalis processing.
what brainstem nuclei are involved in the trigeminal-autonomic reflex? what is the result of this reflex?
trigeminal nucleus caudalis–> superior salivatory nucleus. parasympathetic discharge to face in response to painful stimuli (eg getting hit in the face).
What are the criteria for hemicrania continua.
- lasting longer than 3 months, 2. unilateral pain 3. daily and continuous 4. moderate but with exacerbations, 5. one of the following autonomic features ipsilateral to pain: lacrimation, conjunctival injection, nasal congestion, ptosis and/or meiosis.
what is first line treatment for hemicrania continua?
Indomethacin.
what additional workup should be done in hemicrania continua, autonomic cephalgia, and trigeminal neuralgia?
MRI/MRA with thin cuts through CP angle and meckles cave.
what are headache red flags?
Systemic symptoms or Secondary risk factors (ie prior cancer)
Neurologic deficits
Older age at onset
Onset-abrupt (aka thunderclap)
Progression (change in frequency, severity or clinical features)
What are the criteria for cluster headache?
at least 5 attacks of severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 minutes if untreated with at least one of the following on the ipsilateral side: conjunctival injection and/or lacrimation, ipsilateral nasal congestion and/or rhinorrhea, eyelid edema, facial sweating, miosis and/or ptosis.
what are criteria for paroxysmal hemicrania? What is the first line treatment.
at least 20 attacks similar to cluster headache, but attacks last 2-30 minutes and occur more frequently (>5x/day). Indomethacin is first line tx.
What are the criteria for trigeminal neuralgia?
paroxysmal attacks of pain in distribution of trigeminal nerve lasting under 2 minutes, with triggers. No autonomic features or neurologic deficits.
what is the first line treatment for trigeminal neuralgia?
Carbamazepine
What is the criteria for SUNCT?
at least 20 attacks of unilateral orbital, supra-orbital, or temporal throbbing or stabbing pain lasting under 4 minutes accompanied by ipsilateral cunjunctival injection and tearing.
What is first line acute tx of cluster headache? What is 2nd line?
- Supplemental O2 2. fast acting triptan such as Intranasal or SQ.
