Headache Disorders Flashcards
What are the three types of primary headaches?
Migraine (w/ and w/out auroa) Tension-type headache Cluster headache (and other trigeminal autonomic cephalalgias)
What can cause a secondary headache?
Head and/or neck trauma Cranial or cerebral vascular disorder Substance abuse or withdrawal INfection Disorder of homeostasis DIsorder of cranium, neck, ears, eyes, nose, sinus, mouth, or other facial or cranial structures Psychiatric disorders Cranial neuralgias, central and primary facial pain, and other headaches.
What is the most prevalent type of primary headache?
Tension-type headache
Which two types of primary headaches are more common in women and which one is the most common in men?
Migraines and tension headaches occur more in women
Cluster headaches occur more in men
What primary headache is more common in spring/fall and at night?
Cluster headaches
What is the vascular hypothesis for migraines?
Vasoconstriction in the cerebrum causes aura.
Aura related to changed in blood flow in the cranial vessels reduces blood flow by 25-35%
Followed by vasodilation in the extra cranial and intracranial vessels leading to headache pain.
Serotonin is believed to play important role in migraine development. Many meds used to tx migraines are agonists of the serotonin receptors, causing vasoconstriction, based on the theory that migraine pain result of cranial artery vasodilation.
What is the neuronal dysfunction hypothesis?
Pain of a migraine is through to originate from trigeminovascular system of the cerebrum
The trigeminovascular system is an initiator and promotor of tissue inflammation & when activation it releases neuropeptides that cause vasodilation and inflammation.
What are the modifiable risks for migraines?
Attack frequency Central sensitization Obesity Medication Overuse Stress snoring
What are the non-modifiable risks for migraines?
Sex-female
Low education/socioeconomic status
Head Injury
What are the medications that are common triggers of migraines?
Cocaine Nicotine NTG Hormones NTG Hormones Indomethacin Cimetidine Nifedipine Fluoxetine
What are the Dietary factors that are common triggers of migraines?
ETOH chocolate aspartame monosodium glutamate caffeine Tyramine
What are the environmental factors that are common triggers of migraines?
Bright flashing lights Loud noises Strong odors Tobacco smoke High Altitude Weather changes
What are the lifestyle factors that are common triggers of migraines?
Sleeping disorders
Dieting/skipping meals
Strenuous exercise
What are the hormonal factors that are common triggers of migraines?
Menopause
Menses
Pregnancy
What are the psychological factors that are common triggers of migraines?
Anxiety
Depression
Stress
What is the criteria for a migraine w/out aura (common migraine)?
Must have 2 of the following: aggravated by routine physical activity, pulsating, unilateral, moderate or severe pain
And
At least 1 of the following_ N/V, photophobia/phonophobia
What is the criteria for a migraine w/ aura (classic migraine)?
Criteria at least 2 of the following:
Homonymous visual sx, unilateral sense sx
At least 1 aura sx develops over >/=5 min and/or different aura sx develop in succession over >/=5 min.
Each sx lasts >/= 5min and < / = 60 min
Aura consists of > / = 1 of the following:
Fully reversible visual sx (+ or -)
Fully reversible dysphasic speech disturbance
Fully reversible sensory sx (+ or -)
Approximately 15%; aura allow dx
What are the long-term goals of migraine treatment therapy?
Decrease the number and severity of future migraines
Improves patients quality of life
Supporting the resumption of normal activities Reducing ADRs.
What are the 3 nonpharmacologic treatment?
Ice to head w/ periods of rest and sleep in a dark, quiet environment Avoid triggers Behavioral interventions (relaxation therapy, biofeedback, cognitive therapy)
What is step-therapy?
ACP-ASIM 1st line therapy
NSAIDs (nonsteroidal anti-inflammatory drug) or combo (opiate or migraine drug)
Migraine specific agents if no response to NSAIDS
Involves non-oral route if N/V, guard against medication overuse, educate patients
What is stratified therapy?
USHC 1st line therapy
Migraine specific agents in severe migraine
Involves non-oral route if N/V, guard against medication overuse, educate patients
What are the non-specific pharmacological treatments?
NSAIDs, analgesics, antiemetics (phenergan, compazine), corticosteroids
What are migraine-specific pharmacological treatments?
Ergot derivatives
5-HT1B/1D (seratonin agonists)
NSAIDs
Non-specific meds for migraines
FIrst line for mild to moderate migraines.
Inhibit prostaglandin synthesis (inhibits inflammation in trigeminovascular system)
Includes- ASA (aspirin), naproxen, ibuprophen, APAP + ASA + Caffeine (Excedrin Migraine)
What are the first line NSAIDs?
ASA (aspirin), naproxen, ibuprophen, APAP (acetaminophen) + ASA + Caffeine (Excedrin Migraine)
What are the short-term goals of migraine treatment therapy?
Decrease severity and duration, restore ability to function
Ergotamine acute side effects
N/V (pretreatment with antiemetic) Diarrhea Abdominal pain Weakness Leg cramps Tremor Dizziness Syncope Chest pain Intermittent claudication Syndrome of ergotism
what nonsepecific treatment for migraines involves a local anesthetic into the area where pain is felt?
Intranasal lidocaine
Which nonspecific treatment is reserved for severe migraine HA that is unresponsive to other treatments?
Opioids
Little data for use in migraines
Butorphanol (Stadol nasal spray)
Synthetic narcotic antagonist-agonist
Abuse potential
Barbiturate Combinations (hypnotics)
Non-specific migraine treatment
Combined w/ analgesics or codein
Potential for overuse, mod-severe migraine
EX- butalbital, aspirin & caffeine (fiorinal)
