Headache and other Craniofacial Pains Flashcards
cranial structures sensitive to noxious stimuli
- skin, subcutaneous tissues, muscles, extracranial arteries, external periosteum of the skull
- delicate structures of the eye, ear, nasal cavities, paranasal sinuses
- intracranial venous sinuses, large tributaries
- parts of the dura at the base of the brain an dthe arteries within the dura,
- middle meningeal and superficial temporal arteries
- first three cervical nerves and cranial nerves as they pass through the dura
Projection of pain from the ffg structures
- middle meningeal artery
- intracranial segment of ICA and proximal parts of ACA, MCA
- pain from infratentorial structures
- neck
- 7th, 9th and 10th CN
- back of the eye and temporal area
- eye and orbitotemporal regions
- vertex ad back of the head
- second cervical roots
- nasoorbital region, ear, throat
Mechanisms by which nitroglycerin, nitrates, monosodium glutamate causes headache
dilatataion of intracranial and extracranial arteries
Migraine
highly prevalent and largely familial disorder characterized by periodic, commonly unilateral, often pulsatile headaches that begin in childhood, adolescence, or early adult life and recur with diminishing frequency during advancing years
Aka Migraine with aura
Classic Migraine
Aka migraine without aura
Common Migraine
T/F
In migraine, movement of head intensifies severity of headache
true
Most characteristic features of Migraine
hemicranial
throbbing (pulsating)
ratio of classic (with aura) to common (without aura)
1:5
how many percent of patients have migraine with onset before 30 yrs of age
80%
in migraineurs, the attacks are exclusively perimenstrual in how many percent
15%
mechanism in menstrual migraine
withdrawal of estradiol
T/F
Migraine tends to cease during the second and third trimesters of pregnancy in 75-80% of women.
True
T/F
The use of birth control pills is associated with an increased frequency and severity of migraine and in rare instances has resulted in permanent neurologic deficit
True
food content which has been incriminated as a provocative factor in migraine
tyramine
triggers if migraine
alcohol (red wine or port)
exposure to glare or strong sensory stimuli
sudden jarring of head
rapid changes in barometric pressure
T/F
The incidence of seizures is slightly higher in migrainous patients and their relatives than in the general population.
True
there are syndromes that encompass both disorders
mechanisms implicated in the pathogenesis of arterial occlusion and strokes that complicate migraine
platelet aggregation edema of the arterial wall increased coagulability dehydration from vomiting intense, prolonged spasms of vessels
T/F
Migraine may be a prominent feature in MELAS and CADASIL
True
Sumatriptan acts selectively on which receptors
5-HT1B/D
Side effect of ergotamine
peripheral and coronary vasoconstrictor
headache
how to give ergotamine
1-2 mg tab held under the tongue until dissolved or i combination with caffeine
ergots and triptans are contraindicated in
symptomatic and asymptomatic CAD and poorly controlled hypertension
because of cerebral vasospasm
how to give propranolol as prophylaxis in migraine
10-20 mg x daily and increasing the dose gradually to as much as 240mg/daily
If propranolol is unsuccessful as prophylaxis, what next
may give other beta blockers, lacking agonist properties
atenolol 40-160mg/d
timolol 20-40mg/day
metoprolol 100-200mg/d
if patients are unresponsive after 4-6 weeksm may give Valrpoic Acid 250 3x-4x daily
topiramate or amitryptyline 25-125 mg nightly may be tried
side effect of methysergide i
retroperitoneal and pulmonary fibrosis
indomethacin-responsive headaches
orgasmic migraine chronic paroxysmal hemicrania hemicrania continua exertional headache hypnic headache brief head pains
occurs predominantly in men
severe consistent unilateral orbital localization
nightly recurrence between 1 and 2 hr after the onset of sleep or several times during the night
cluster headache
treatment of cluster headchae
100% oxygen via face mask for 10-15 mins at the onset of cluster headache may abort the attack
Other meds for cluster headache
verapamil 80mg QID
ergotamine 2mg at night
intranasal lidocaine or sumatriptan may be useful to abort an attack
T/F
The incidence of tension headache is certainly greater than that of migraine
True
T/F
Like migraine, tension headaches are more common in women than in men
True
T/F
Unlike migraine, tension headaches infrequently begin in childhood or adolescence but are more likely to arise in middle age.
True
inflammatory disease of cranial arteries patients are older than 55 increasingly intense throbbing or nonthrobbing headache with superimposed sharp/stabbing pains sometimes explosive localized to affected arteries on scalp
Headaches of Temporal Arteritis
Importance of early diagnosis of Temporal Arteritis
threat of blindness from thrombosis of the ophthlamic or posterior ciliary arteries
T/F
Large intracranial vessels are occasionally affected in Temporal arteritis, thereby causing stroke
True
T/F
In temporal arteritis, once vision is lost, it is seldom recoverable.
True
Biopsy result of scalp artery in Temporal arteritis
intense granulomatous, or giant cell arteritis
Treatment for Temporal Arteritis
prednisone 45 to 60mg/day in single or divided doses over a period of several weeks
with gradual reduction to 10-20mg/day and maintenance at this dosage for several months or years
Headache can be expected to improve within a day or two of beginning treatment, failure to do so brings the diagnosis into question
treatment for trigeminal neuralgia
Carbamazepine is effective in 70-80% of patients 600-1200mg/d phenytoin 300-400mg/d Valproic Acid 800-1200 mg/d clonazepam 2-6mg/d gabapentin 300-900mg/d pregabalin 150-300mg/d
