Headache - Block 2 Flashcards
What are examples of primary HA?
- Migraine
- Tension
- TAC
What are the causes of secondary HA?
- Trauma or injury to the head and/or neck (e.g., SAH)
- Cranial and/or cervical vascular disorder
- Non-vascular intracranial disorder
- A substance or its withdrawal
- Infection (e.g., meningitis)
- Disorder of homoeostasis
- Disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structure
- Psychiatric disorder
What are the causes of migraines?
Polygenic:
1. Activation of subcortical structures
2. Neural suppression
3. Activation of trigeminal systems
Migrain pain and sx
What is the cause of migrain pain?
The trigeminovascular system is considered to be the anatomical and physiological substrate from which nociceptive transmission originates
What are the types of migraines?
- Migrain without aura
- Migrain with aura
- Chronic migraine
What are the diagnosis of migraine without aura?
At least five attacks that meet the following four criteria:
1. Headache lasting 4–72 hours
2. Headache with at least two:
* Unilateral location
* Pulsating quality
* Moderate or severe pain intensity
* Aggravation
- HA accompanied by one of the following:
* N/V
* Photophobia/phonophobia
What are sx of a typical aura?
Visual: flashing lights, zig zag lines, loss of vision
Sensory: tingling or numbness across different body parts
Speech: difficulties with word formation and comprehension
What are the sx of hemiplegic migraine?
Visual: flashing lights, zig zag lines, loss of vision
Sensory: tingling or numbness across different body parts
Speech: difficulties with word formation and comprehension
Motor: temp weakness, unilateral of the arms, hands, legs, feet, tongue, or face
What is the presentation of migraine with aura?
At least two attacks that meet the following criteria:
One or more of the following fully reversible aura symptoms:
* Visual
* Sensory
* Speech, language, or both
* Motor
* Brain stem
* Retinal
At least three of the following six characteristics:
* At least one aura symptom spreading gradually over a period ≥5 minutes
* Two or more aura symptoms occurring in succession
* Each aura symptom lasting 5–60 minutes
* At least one unilateral aura symptom
* At least one positive aura symptom
* Headache accompanying the aura or following the aura within 60 minutes
What are the presentations of chronic migraines?
≥15 days/month for >3 months that fulfill the following criteria:
* least 5 attacks
* ≥8 days/month for >3 months
What does a comprehensive HA history contains?
- Age at onset
- Attack frequency and timing
- Duration of attacks
- Precipitating or aggravating factors
- Ameliorating factors
- Description of neurologic symptoms
- Characteristics of the headache pain (quality, intensity, location, and radiation)
- Associated signs and symptoms
- Treatment history
- Family and social history
- Impact of headaches on daily life
What is goals of treating acute migrains?
- Treat migraine attacks rapidly and consistently without recurrence
What is the goal for treating chronic migraines?
Reduce migraine frequency, severity, and disability
What is nonpharm for acute migraines?
Ice to the head and periods of rest or sleep, usually in a dark, quiet environment
What is the non pharm for prevention of migraines?
- Avoid triggers
- Wellness programs
- Behavioral interventions
What should a HA diary contain?
- Frequency
- Severity
- Duration of attacks
- Response to med
- Potential trigger factors
What are food triggers for migraines?
- Alcohol
- Caffeine/caffeine withdrawal
- Chocolate
- Fermented and pickled foods
- Monosodium glutamate (eg, in Chinese food, seasoned salt, and instant foods)
- Nitrate-containing foods (eg, processed meats)
- Saccharin/aspartame (eg, diet foods or diet sodas)
- Tyramine-containing foods
What are environmental triggers?
- Glare or flickering lights
- High altitude
- Loud noises
- Strong smells and fumes
- Tobacco smoke
- Weather changes
What are behavioral triggers?
- Excess or insufficient sleep
- Fatigue
- Menstruation, menopause
- Sexual activity
- Skipped meals
- Strenuous physical activity (eg, prolonged overexertion)
- Stress or poststress
What are acute pharm tx for migraines?
Nonspecific: analgesics, NSAIDs, antiemetics, CS
Migrain specific: ergots, triptans
What are acute migraine tx most effective?
At onset of migraines
When should NSAIDs and analgesics be used for migrains?
- mild-to-moderate migraine attacks
- severe attacks that have been responsive in the past
Types of Analgesics used for migraines?
- Aspirin
- Diclofenac
- Ibuprofen
- Naproxen
- acetaminophen + aspirin + caffeine
- APAP
What is med overuse HA?
A pattern of increasing headache frequency and drug consumption
How do you tx med overuse HA?
Discontinuation of the offending agent -> gradual decrease in headache frequency and severity -> return of the original headache characteristics
How do you avoid the development of med-overuse HA?
Limit use of acute migraine therapies to fewer than 10 days per month
Appropriate first-line therapy for patients with mild-to-severe migraine and also for rescue therapy when nonspecific medications are ineffective?
Serotonin Receptor Agonists (Triptans)