Headache Flashcards
What are some examples of a Primary Headache?
Tension, custer, migraine, chronic daily headache
What are some examples of secondary headaches?
Brain tumour, cerembral aneurysm, head trauma, meningitis,
How would you describe a tension type headache?
Bilateral, pressing or tightening quality. “Like a band”. Mild to moderate pain. No nausea or vomiting. Could have photophobia or phonophobia. Ordinary physical activity does not aggravate it.
How long does a tension headache last?
30 minutes to 7 days. Duration is variable.
Someone has infrequent episodic headaches, how often is that?
Fewer than 1/month
Someone has frequent episodic headaches, how often is that?
At least 10/month for 3 months
Someone has chronic headaches. How often is that?
> or equal to 15/month for 3 months.
What are some causes of tension headaches?
Can be attributed to tension in muscles of the head, neck, and shoulders, TMJ or other oromandibular dysfunctions, stress and anxiety, flexion-extension injuries, or poor posture.
What causes TMJ?
Poor bite, teeth grinding, join problems like trauma degeneration or inflammation.
How do you describe a cluster headache?
Severe, unilateral headache, described as steady, excruciating, debilitating, non-throbbing, penetrating. Pain can occur around the eye and may extend toward the ear.
What are some associated symptoms of cluster headaches that have to do with the eye and ear?
Eye redness, lacrimation, nasal congestion, runny nose, facial sweating, drooping eyelid on the affected eye.
How long do cluster headaches last?
Can really range. They come on suddenly and reach max intensity within 15 minutes and last less than 3 hours.
How frequently can someone get them?
Every other day in mild cases, or 8 times a day in severe cases
Why are they called “cluster headaches”?
Because you usually get this together in a period of time like 2 weeks to 3 months and then they remiss over 6-12 months.
Are cluster headaches more common in men or women?
Men aged 20-40 years old.
What factors make someone more likely to get cluster headaches?
There’s a genetic component. And also people with cluster headaches are associated with cigarette smoking.
Who’s most at risk of getting a migraine?
3x more likely in women. Caucasians also more often get them.
What type of migraine is more common, migraine without aura or with aura?
Migraine without aura.
Does a migraine affect bilateral sides of head or is it unilateral?
Unilateral
How severe are migraines?
Moderate to severe and often incapacitating.
What are the symptoms of a migraine?
Unilateral, associated with nausea, vomiting, photophobia and or phonophobia. Aggravated by routine physical activity or head movement. Relieved by sleep.
With patients who experience an aura, when do they experience it?
It precedes the headache. Usually 5-20 minutes and lasts less than 1 hour. Completely reversible - stops when the headache stops.
What are some examples of positive symptoms of aura?
Flashing lights, tingling, zig zap pattern
What are some negative symptoms of aura?
Blindspot or numbness.
What are some sensory auras?
Tingling, or numbness affecting one arm or side of face
What’s a motor aura?
Limb weakness on one side of the body
What’s a dysphasic aura?
Speech disturbance
Someone says their mother got migraines - is this a significant piece of health history?
Yes, 70% pts who get migraines have a 1st degree relative with migraines. They have a lower threshold to migraine triggers - a “sensitive brain”.
What’s another cause of family related migraines?
Familial hemiplegic migraine - rare - A single gene defect affecting neuronal calcium channels - autosomal dominant inheritance - one sided muscle weakness
List some common triggers of migraines?
Chocolate, alcohol, aged cheese, MSG, aspartame, caffeine, nuts, nitrites. Menses, ovulation, progesterone. Strong light, flickering lights, odors, sounds. Let down periods, intense activity, loss/change, moving, crisis. Changes in environment - weather, travel, seasons, altitude, schedule changes, sleeping patterns, dieting, skipping meals, irregular physical activity.
Why do some women experience less migraines in menopause?
Cyclic fluctuations in estrogen trigger migraines - like ovulation and menstruation. Some women also get migraines because of oral contraceptives or hormone replacement therapy. They go away when people also are pregnant. Estrogen causes changes in catecholamine release.
What is the pathophysiology of a migraine trigger?
A wave of neuronal depression spreads across the cortex from the occipital region activates the trigeminovascular sytem in those genetically predisposed.
What part of that causes the aura?
The wave of neuronal depression. If comes from the occiput which can cause visual symptoms. Neuronal depression can cause the blind spot or scotoma. Flickering or zig zags of light (aka scintillations) can be from the occiput as well.
What does the trigeminal nerve innervate?
Meningeal blood vessels, muscles and blood vessels around the scalp face and neck. It contains nociceptors that generate pain impulses (the brain tissue doesn’t have any nociceptors).
What does the nociceptors sense?
They aren’t specific. They get triggered from noxious stimuli like pain, mechanical stimulation, smells, stretching of meninges, or vessels of the meninges etc.
Where are the neuropeptides that cause migraines released from?
Trigeminal nerve endings are stimulated to release neuropeptides at the neurovascular junction (meningeal blood vessels).
What are some names of some of the neuropeptides?
Calcitonin gene related peptide (CGP), substance P or Neurokinin A
What do neuropeptide do in migraines?
1) Act on mast cells which release histamine and that causes meningeal blood vessels to become more permeable and prone to neurogenic inflammation of meninges.
2) Neuropeptides also act on nociceptors and lower the threshold of activation. They become more responsive to a given stimulus causing peripheral sensitization.
What is the path of the pain from the trigeminal nerve?
The trigeminal nerve relays nerve impulses to the prain stem at the trigeminal nucleus caudalis. Neurons then innvervate to the thalamus and sensory cortex for pain perception.
Where might nerve impulses go if they were light or sound sensitivities?
The hypothalamus
Why do some people with neck pain experience migraines?
Upper cervical dermatomes synapse at the same place as the nucleus caudalis
Why do some people get a “throbbing” headache with migraines?
The sensitized peripheral nerve endings are attached to a pulsating artery or near an area that moves.
When is the prodromal period of a migraine?
Some people can sense they’re going to get a headache 24-48 hours before the migraine. Symptoms might include yawning, food cravings, irritability, euphoria, fatigue, lack of concentration, sensitivity to light or sound
What’s a post drome?
Headache pain is gone but they might have like a migraine hangover. Persistent sensitivity to light and movement, fatigue, difficulty focusing, or food intolerance. Lasts 1-2 days.
How do we treat migraines?
Ice, rest (dark noise free room), analgesic, antiemetics, triptants, and fluids
What are triptans?
They are serotonin receptor agonists that block the release of inflammatory mediators and inhibit pain transmission. They prevent vasodilation and vasoconstrict.
When should someone take meds for migraines?
If they happen 2-3 x/month and are disabling. If abortive therapy is ineffective or produces side effects.
What are some meds that treat migraines?
Beta blockers, calcium channel blockers, antidepressants and antiseizure meds. Should be taken daily.
