Headache - Ishmael Flashcards
What are the four main types of headaches?
- Sinus
- Migraine
- Cluster
- Tension
Which type of headache is more common in men, where the pain is centered behind the eye?
Cluster headaches
Which headache is characterized by pain, nausea, and visual changes most classically?
Migraine headache
Which headache is described by pain in the head similar to a hat band squeezing the head?
Tension headache
Which headache has pain behind the forehead and/or cheekbones?
Sinus headache
Which headache may be a secondary headache?
sinus headache is usually secondary to a bacterial infection
What differentiates migraines from other headaches?
The associated symptoms
What could be some causes of secondary headaches?
Infection Head injury Vascular condition Tumor Substance abuse/withdrawal GI disorders
What is the most common primary headache, and is normally associated with stress, anger, and fatigue?
The tension headache
With tension-type headaches, is pain usually associated with nausea, photophobia, or phonophobia?
Not usually nausea, but maybe photophobia or phonophobia (but not both).
Is a tension headache usually worse upon exertion?
No.
How long does a tension headache last if untreated?
30 minutes to days.
What non-pharmacologic treatments could be used for a tension headache?
- Palpation of muscles
- Stress management (behavioral treatment, relaxation training, biofeedback)
- 33-64% reduction in HA activity
What pharmacologic treatments are available for tension headaches?
- OTC simple analgesics (APAP, ASA, NSAIDS) with or without caffeine (may help analgesic be absorbed in the brain)
- high dose NSAIDS
- Combination with butalbital (barbiturate) or codeine (opiate)
How long should you use medications containing butalbital?
Less than 4 days a month
How long should you use combination analgesics?
Less than 10 days a month
How long should you use NSAIDS?
Less than 16 days a month
What symptoms must you have in order to have a migraine?
Recurrent attacks of pain plus associated symptoms during the pain: either 1) nausea and/or vomiting or 2) photophobia and phonophobia
What migraine and cluster headaches have in common?
They are vascular headaches (superficial vessel dilation)
How long do untreated and unsuccessfully treated headaches last?
From 4 to 72 hours
How are migraines described?
Unilateral pain that is pulsing, moderate to severe intensity, aggravated by routine physical stimuli.
How are hormone levels a factor in migraines.
They are more common in women than men, and up until puberty, they are just as prevalent in boys as girls. After puberty, they are three times higher than girls than boys. After menopause, symptoms may improve.
What would hormone therapy do to migraine prevalence in women, theoretically?
It would even out fluctuations and act as prophylaxis ..r reduce risk of migraines.
What is an aura?
- When symptoms preceded headache by 10-30 minutes (60 max) and include sensory warning signs.
At least one of the following symptoms must be included: - Reversible visual symptoms
- Reversible sensory symptoms
- Reversible speech disturbances
Usually composition of headache is similar from attack to attack.
In which part of the brain is the activity changing in an aura?
It is a cortical spreading depression, characterized first by transient waves of activity in the cerebral cortex (extensive glutamate release).
What are the four phases in a migraine attack?
Prodrome premonitory
Aura
Pain and associated symptoms
Postdrome
Which phase does the trigger occur in?
The prodrome phase. Irritability, fatigue, cravings, mood changes, muscle tension could all be factors.
What are the vascular and neurogenic components of a migraine?
The vasculature
The trigeminal nerve
Serotonin
Describe the pathway of a migraine from trigger to headache:
Trigger initiates a nociceptive response Causes dilation of blood vessels Causes neurogenic inflammatory response Pain Further nerve activation
What does a nociceptive response normally accomplish?
Activation of nociception usually warns and provide sensory information about tissue damage or inflammation
What is the term for a condition of disturbed ion transport?
Channelopathy
What is familial hemiplegic migraine? What mutation do they have? In what gene?
It is a rare, inherited form of a severe migraine with aura. The aura is characterized by a sudden attack of unilateral weakness that seems like a stroke.
They have a mutation in the alpha subunit of the voltage-gated P/Q type calcium channel. 15 mutations identified in the alpha subunit contribute to this disorder.
What medication would a person with familial hemiplegic migraines take prophylactically?
Verapamil, which is a calcium-channel antagonist
How is the Ca(V)2.1 related to migraines?
It is expressed in all areas implicated in the pathogenesis of migraine: trigeminal ganglia, brainstem nuclei involved in nociception, cerebral cortex.
What do the mutations in Ca(V)2.1 alpha subunit cause?
They have an inappropriate hyper excitability
What does the pain in a migraine headache come from?
It comes from the dilation and distention of cerebral blood vessels. There is a vein running through the subarachnoid space between the arachnoid and the pia mater (which lines the brain tissue). The innervation of these blood vessels is derived from the Trigeminal nerve (cranial nerve V). So the inflammation of the meninges at the level of the meninges is what causes the pain.
What are the three meninges?
Dura mater
Arachnoid
Pia mater
When information from the vessels within the meninges is collected, where does it go?
It is collected from within the meninges and the brainstem, and carried to the brain stem. The pain message is perceived by the thalamus and the cerebral cortex.
What stops the pain of the headache?
When the firing rate of the trigeminal nerve is reduced.
What explains the associated symptoms of a migraine?
The projection of the trigeminal nerve to other areas of the brain, which causes the nausea, photophobia, and phonophobia.