Headache and Migraine Flashcards
What are the 3 main primary headaches? How likely are they?
Tension (80%)
Migraine (20%)
Cluster (0.2-0.3%)
Which primary headaches are more common in females?
Tension and migraines
Cluster headaches are more common in males
What are the characteristics of a tension type headache?
Band like
Bilateral
Tightness/pressure
Radiates to neck/shoulders Mild to moderate
How do you treat tension type headaches?
Simple analgesics
Will disappear soon after noxious stimulus has ceased
What are the characteristics of cluster-type headaches?
Affects one side of head Triggered at sleep Can get up to 8 attacks Eye very affected - red, watery Get rhinitis
How do you treat cluster type headaches?
High flow oxygen 100% 7-15L per minute (oxygen acts as a vasoconstrictor)
Other vasoconstrictors - triptan (in red bull)
How do you diagnose a migraine?
Does light bother you more?
Does it affect your ability to work/study/do a task?
Do you feel nauseated/sick?
If yes to 2/3 - 93% migraine diagnosis
How are migraines associated with genetics?
- inherit ‘over responsive’ brain
- heightened sense to smell/lights/sounds/touch
What is the migraine threshold?
- number of triggers build up (e.g. lack of food, dehydration, lack of sleep) and add on, if go over the threshold of triggers you will get a migraine
What are the types of migraine and how common are they?
Migraine without aura - 70-80% of attacks
Migraine with aura - 20-30% of attacks, 1& without headache
What are the 5 stages of a migraine?
1 - premonitory 2 - aura 3 - headache 4 - resolution 5 - recovery
What is the mechanism of the premonitory stage of a migraine?
- mood deterioration/neck stiffness 48 hours before migraine
- serotonin release
- symptoms come from hypothalamus
How do you treat the premonitory stage of a migraine?
Focus on replenishing serotonin stores - triptan acts on 5HT1D/B agonists
What are the characteristics of aura?
Visual (99%) and/or sensory and/or speech/language symptoms
True aura remains even when eyes are closed
What are the causes of aura?
Cortical spreading depression:
transient and local suppression/depression of spontaneous electrical activity in the cortex which moves slowly across the brain
What is stage 3 of a migraine associated with?
Trigeminovascular pathways
What is stage 4 of a migraine?
Resolution - deep sleep, medication to promote sleep, vomiting
What are the trigeminovascular pathways?
- start in the meningeal blood vessels releasing serotonin causing dilation
- neuropeptide release (CGRP)
- neuropeptides activate nerve pathways to the trigeminal ganglion (peripheral sensitisation mediating throbbing pain)
- trigeminal nerve transmits pain impulses to spinal trigeminal nucleus caudalis in brainstem (central sensitisation mediating allodynia)
- pain message relayed to thalamus
- perceived by patient as headache
What is CGRP?
Neuropeptide
Potent vasodilator
Rises during migraine
What are CGRP receptor antagonists?
Gepants
What is allodynia?
Over sensitvity
What is the difference between peripheral sensitivity and central sensitivity?
Peripheral - mediates throbbing pain
Central - mediates allodynia
What are the 2 sites of action for migraine treatment? Which drugs do which?
- preventative: central (CGRP monoclonal antibodies)
- acute: peripheral (triptans)
What are some examples of triptans?
Sumatriptan
Naratriptan
Zolmitriptan
What are some examples of CGRP monoclonal antibodies?
Erenumab
Fremanezumab
Eptinezumab
How do you diagnose secondary headaches?
Diagnosis made on history of presence of physical signs
