Headache And Migraine Flashcards
Possible underlying causes of secondary headaches
- Exposures = carbon monoxide, dehydration
- Infection
- Brain related = blood clot, brain tumour, concussion, stroke
- Other
Glaucoma
High blood pressure
Features of tension headaches
Bilateral
Pull pain, tightness on scalp or neck
No nausea
Pathophysiology of tension headaches
- Peripheral = low tolerance to mechanical, thermal and electrical pain perception
More tender pericranial myofacial tissue - Central = increased excitability of CNS
- GENETIC
Alarm symptoms for tension headaches and Migraine
- Older than 50, sudden onset
- Onset after head trauma
- Increased severity and frequency over weeks or months
- New onset in ppl with HIV, cancer
- With signs of systemic illness
- Confusion and reduced mental abilities
- Positional headache (worsen when standing)
- Cough headache
- Suspected cluster headache!!
Non pharma treatments
- CBT
- RELAXATION TRAINING
- BIOFEEDBACK
- Physical relaxation
- Acupuncture
- Physiotherapy
Pharmacological treatments for headache
Paracetamol
Aspirin
NSAID - ibuprofen
Migraine clinical features
Unilateral pain
Pulsating, throbbing
Aggravated by exertion
Nausea +- vomiting
Sensitivity to light
Aura
4 phases of Migraine
- Prodrome = hours before
- Aura = before headache phase
- Headache
- Postdrome = effects after the headache (fatigue, depressed mood, lack of concentration)
Pathophysiology of migraine
Changes in waves of activity by excitable brain cells => change in 5HT level => cerebral blood flow changes contribute to pain
Cerebral blood flow changes in stages
- Prodrome
= vasocontriction (Inc. Serotonin) - Aura
=hypoprofusion - Headache
= vasodilation (Decr. Serotonin)
= hyperprofusion
Acute treatment of migraine
Non- opioid analgesic = paracetamol, aspirin, nsaid
Antiemetic = metioclopramide, ondansetron
Triptan =
Moa of Triptan
Agonist of 5HT 1B/ 1D
Receptors
Inhibits the abnormal activation of trigeminal nociceptors
- constriction of peripheral nociceptors
- decrease cerebral blood flow
- inhibit pain transmission in CNS
When should triptans be taken?
When headache is about to develop
Do not take Triptans within 24 hrs of ergometrine or
Ergometrine within 6 hrs of a triptan
= risk of vasospasm
Can SNRI or SSRI users tale Triptan?
Yes
But be ware of serotonin toxicity
Which Triptan’s cannot be taken with MAOI?
Naratriptan
And
Eletriptan
