Headache and migraine Flashcards
what is a primary headache? give exampls
NO detectable underlying cause
- tension type headache
- migraine
- cluster headache
what is a secondary headache?
caused by UNDERLYING condition
extracranial (otitis) or intracranial (meningitis)
tension type headache
- how does it feel? (symptoms)
- duration
- location
- prevalence
- prevention measures
- treatment
feeling of pressure and tightness across the forehead, NO other symptoms (NV, aura) hours, episodic bilateral across both side of brain 80% population, more common in women good sleep routine, stress mgn OTC: 1st paracetamol, NSAIDS 2nd aspirin+paracetamol+caffeine
what is medication over headache
is it prevalent
how to mgn
1% of world population. caused by using analgesic for long period of time, paracetamol >15d/m, triptans or opioid or combo>10d/m
limit trt to 2-3d/w
migraine
- how does it feel? (symptoms)
- duration
- location
- prevalence
- contributing factors
- lifestyle
- throbbing, pulsating, moderate to severe pain. worsen w exercise. photo/phonophobia +/- aura- visual disturbancesn+/- NV
- 4h to 3d
- unilateral is common
- 10% of population. same prevalence in pre-puberty for m+f, post puberty- rise to 20% in menstruating women- falling oestrogen levels. less common in post-menopause women
- genetic factor 50% chance if 1st degree relative has migraine
envrionmental factors: triggers eg food, sleep,lights. - rest in a dark quiet room
what is the frequency of migraine episode per month for most of the migraineurs
> 1 episode per month
what is the name of the migraine with/without aura
with aura- classic migraine
w/o aura- common migraine
WHO global burden of disease 2015- migraine is the … leading cause of disability in under 50s
third leading cause
phases of migraine headache
prodromal or premonitory phase (not sudden onset) visual disturbances, emtional changes (anxiety, panic),N, fatigue headache phase (pulsating, throbbing, continous pain unilateral, behind the eyes) resolution phase (lack of concentration, tired)
what is aura?
focal neurological disturbance accompanying headache, may include - motor features/ sensory disturbance (visual)
what causes aura
- CSD- cortical spreading depression- slow wave of depolarisation
- decreased regional cerebral blood flow-> period of inactivity of brain (depressed)
causes of migraine PAIN
- CNS itself lack of sensory pain rec,
- all nociceptor are priphery
- but the intracranial bv in dura mater (meninges) and circle of Willis arteries (base of brain) are supplied w sensory nerves (from ganglia) that can respond to thermal, mechanical distension stimuli
three theories of causes of migraine pain
1 vascular theory- intra-cerebral bv vasoconstriction + extra-cerebral vasodilation
2 neuronal theory- CSD a wave of neural inhibition-> ionic imbalance and local q reduction
3 inflammation theory- activation of trigeminal nerve terminals in meninges and extracranial bv nociceptors, release of neuropeptides (subp) and inflam mediators
describe the neurovasuclar model in causes of migraine pain
neurovasuclar model- the trigeminovascular pathway.
- CSD kick off the process? AP from cranial artery
- trigeminal ganglion release CGRP
- vasodilation in cortex, pia, dural bv
- local inflammation
- activates TG and trigeminal nucleus caudalis stimulate rostral brain areas
- pain from brainstem to thalamus to cortex
- central sensitisation
how many 5ht rec are there
are they all GPCR?
5HT1-7
only 5HT3 is inotropic
