Headache Flashcards
Headache caused by mutation in ion channels
Familial hemiplegic migraine
Alterations in membrane excitability predispose to HAs (V-gated Ca and Na channels)
Familial hemiplegic migraine
This HA has at least 2 of the following: UL pain Throbbing Worse w/ mvmt Mod-Severe intensity
And 1 of:
N/V
Photophobia/Phonophobia
Migraine
Tension Migraine Idiopathic stabbing Exertional Cluster
Primary HA
Head injury Systemic infection Vascular d/o Brain tumor Subarachnoid hemorrhage
Secondary HA (caused by external force)
Cranial structure that produces pain?
Dural sinuses*
Scalp, dural sinuses, middle meningeal artery, falx cerebri, and proximal segments of large pial arteries
Most common type of primary HA?
Tension HA 69%
Migraines only 10%
Most common sx with severe migraines?
Nausea 85%
Triptans are agonists of which receptors?
Serotonin (5HT1b and 5HT1d)
Grouping of primary HAs including cluster HAs, paroxysmal hemicrania, SUNCT (short-lasting UL neuralgiform HA attacks w/ conjunctival injection and tearing), SUNA (short-lasting UL neuralgiform HA attacks w/ cranial autonomic sxs), and hemicrania continua
Trigeminal automonia cephalalgias
Migraines w/ aura are not included
Pts often misdx as sinus HA and given decongestants which do not help
Lacrimation, conjunctival injection, nasal congestion
Cranial autonomic sxs
Treatment of choice for paroxysmal hemicrania
Indomethacin
Effective tx for cluster HAs
Verapamil
Most migraine sxs can be induced by dopaminergic ____________
stimulation
Ppl with migraines have dopamine receptor
hypersensitivity
Pathway for pain in migraines:
Trigeminovascular input from _______________
middle meningeal vessels
Trigeminovascular input from middle meningeal vessels === Trigeminal ganglion ===== Second order neurons of \_\_\_\_\_\_
Trigeminocervical complex
Innervation of large intracranial vessels and dura matter done by which CN?
Trigeminal nerve
Trigeminovascular system
Preventative med for migraines
Propranolol
Acute tx for migraines
Sumatriptan
Metoclopramide
Preventative med for cluster HAs
Verapamil
Most effective tx for preventing short-lasting UL neuralgifrom HA attacks with conjunctival injection and tearing (SUNCT) is
Lamictal
5HT1B/1D receptor agonists
Dopamine receptor antagonists
NSAIDs
Classes of drugs that tx migraines
