Headache Flashcards
1
Q
percentages of adults with HA disorder
A
- 46% in general
- 11% Migraine
- 42% Tension
- 3% chronic daily HA
- To 10 most disabling conditions for both genders worldwide (2007)
- 16% of adults report migraine or other severe HA in last 3 months
- 5th leading cause of ED visits and 1.2% of all office visits (2013)
- Cluster HA more common in males but tension are more common in women
- 5:9 M:F
- 90% primary
- Australian study showed 15% of population used headache meds
2
Q
primary headache types
A
- tension
- migraine
- cluster
3
Q
tension headache
A
- Most common primary HA
- Constant, daily HA
- Worst late in day – usually pts don’t wake up with the headache, they get it throughout the day and get worse
- Bilateral – usually back of the head, back of the neck
- Vise-like, “band”
- Emanates from neck and shoulders
- “Featureless” HA – they don’t have very specific qualities to them
- Constant, daily HA
4
Q
primary headache
A
- HA and associated features are the disorder
- Tension 69%
- Migraine 16%
- Cluster 0.1%
5
Q
secondary headache
A
- HA caused by other disorder
- Infection 63% - sinus infection (hurts on front of face, purulent discharge, leaning forward hurts) (Meningitis – you feel like crap, nuchal rigidity, Dental abscess)
- Trauma 4%
- Vascular Disorder 1%
- SAH <1%
- Tumor 0.1%
6
Q
mechanism of tension HA
A
- No significant increase in muscle tone in HA sufferers – probably more about inflammatory pathways getting triggered – neuronal inflammation
- Research now focused on changes in brain chemistry that activate pain pathways and inhibit suppression of pain
7
Q
S.C.A.L.P
A
- Skin
- Connective Tissue
- Aponeurosis
- Loose connective tissue
- Pericranium
- You can have inflammatory markers that affect any of these layers
8
Q
Tension HA triggers
A
- Stress – common
- Depression/Anxiety – common, particularly in those that have daily headaches (They will often times wake up in the morning with the headache, Will still get worse throughout the day like a tension headache)
- Posture – clenching shoulders, etc. (Focus on fixing ergonomic body posture at work)
- Jaw clenching
- Female
- Middle age
9
Q
acute management of tension HA
A
- Simple analgesia (Add caffeine) - When people get a tension headache, they vasodilate so caffeine will help by vasoconstricting
- Avoid opiates
- Avoid rebound
- Avoid triggers
10
Q
Preventative managment
A
- TCA (amitriptyline) – this has been the most studied and effective for headaches
- EMG biofeedback with relaxation therapy – triggering the muscles at the back of the neck with electrical stimulation (Massage therapy can be helpful for acute headaches, not really chronic, TENS can be used for tension headache as well – it is electrical stimulation of the muscles)
- Acupuncture
11
Q
migraine
A
- “We can describe the thoughts of Hamlet, but we cannot describe a Migraine.”
- 2nd MCC HA
- 17% females and 6% of males in US
- Females are triggered around puberty and males tend to start earlier
- Higher in boys prepubertally, then flips – this is because boys start earlier but there are more women in general that start once puberty hits
- Incidence peaks in teen years
- FH in 70% of patients
12
Q
migraine pathophysiology
A
- Wolff et al (1940s) theorized vasoconstriction responsible for aura, followed by dilation (pain)
- Probably neurovascular (Neuronal hyperexcitability demonstrated in migraneurs without HA, Aura explained by theory of cortical spreading depression of Leao (1944) – wave of excitation followed by depression)
- Related to vasodilation (CN V) – stimulated by ions from cortical activity (Cortical spreading depression is a widespread wave that triggers inflammatory mediators to be released and vasodilation in trigeminal system - Depolarizes cortex that cause vasodilation and inflammation)
- Parasympathetic nerve fibers
- MRI studies show modified activity in brainstem regions relating to sensory processing – even after pain aborted with meds (Weiler)
- Regional cerebral blood flow diminished followed by hyperemia
13
Q
migraine triggers
A
- FH in 70%
- Stress 80%
- Lack/excess of sleep >50%
- Missed meals 57%
- Foods (chocolate, EtOH) 27-38%
- Light/noise 38%
- Odors 44%
- Menstruation (catamennial) 65%
- Weather changes 53%
14
Q
migraine clinical findings
A
- Unilateral
- Throbbing
- Episodic with early onset – usually start in childhood (New diagnoses later in life is not as common)
- Anorexia
- N/V
- Photophobia/phonophobia/osmophobia
- Cognitive impairment – problem with word finding or confusion
- Blurred vision
- Build gradually, last hours to days
- Focal neurological deficits, or sensations may precede onset – i.e. tingling in the 3rd and 4th finger or blurring of one eye
- NOT EVERYONE GETS AURA!!
15
Q
chronic migraine
A
- Frequent or long lasting migraines
- Migraines causing significant disability or decreased QOL
- Consider prophylactic therapy: Improve QOL, decrease disability, Decrease risk of neurologic damage in uncommon migraine types, Patients who have failed, have contraindications to, or serious adverse effects with acute therapies, Menstrual migraine
