Headache Lecture Flashcards
what is the difference between a headache and a migrane?
a headache is a symptom (can be a symptom of many disorders and conditions) and a migrane is an actual DIAGNOSIS
Where do headaches come from or originate?
may come from pain sensitive structures of the head
What are the most common areas of the brain that need to be evaluated?
intracranial (in the brain) and extracranial (outside the brain) structures
- extracranial structures include:
1) skull fractures, or inflammation on the lining of skull
2) inflammation on or near teeth
3) inflammation of skin over top of skull
4) tension spots in the back of the head and neck (muscle)
5) Hurting of the muscles of the face and forehead
6) sinuses can cause tension type headaches
Intracranial structures include:
1) lining of brain (meningis)
2) eyes
3) blood vessels in the brain
What nerves innervate the head? and at which locations? how do these nerves cause headaches?
the intracranial structure above the tentorium (right above cerebellum) are innervated by trigeminal nerve (CN V)
the intracranial structure below the tentorium (below the cerebellum) are innervated by cervical nerves
when these sensory nerves are inflammated and sensitized (repeated administrations of stimulus causing progressive amplification of response) is common to more than one cause of headache
What is the overall process of how headaches occur?
pain sensitive structures in the brain (in the paravascular area) become sensitized and release inflammatory mediators called CGRP and substance P, these inflammate the trigeminal nerves and make them sensitized therefore causing pain
What are 5 common headache patterns?
- first or worst headache (first headache with the highest intensity) can be dangerous
- recurring headache with autonomic features swelling of eyes, sinuses, runny nose..etc..
- episodic headache
- high frequency and chronic headache
- progressive headache
the temporal pattern/how often it occurs can say alot about the underlying cause of the headache
What is an example of a first or worst headache? What does it indicate?
an example: Thunderclap headache
- reaches to 7/10 or more in one minute
- it is a subarchanoid hemorrhage most of the time or related to other vascular problems in the brain like:
1. RCVS (Reversable vasoconstriction syndrome) occurs when u do certain drugs, results in a basal spasm of middle cerebral artery and then it goes away)
2. ceberal artery dissection
3. pituitary apoplexy
4. sinovenous thrombosis
5. PRES
or from other things like infections..e.tc..
this headache should NEVER be missed because its deadly
What are 3 ways we can assess thunderclap headaches?
- CT Scan
- CT angiogram
- Lumbar puncture for infections
What are trigeminal autonomic cephalagias?
they are short but tense headacheds associated with autonomic features and differentiated by duration
cluster headaches are most common and last 15-45 mins
What are some characteristics about cluster headaches?
- person tends to want loud noises and high stimulation (not quiet and peace) to get passed it
- oxygen is a useful treatment for acute attacks
- usually immetrix is taken
What is an episodic headache? when does it occur?
- recurrent moderate to severe headache
- usually a migrane with or without vomiting, it could be bilateral or unilaterual, photophobia (cant stand light) and phonophobia (cant stand sounds) and gets worse if u continue with ur activity
99% of ppl who get these have normal brain imaging
What are 3 types of headaches according to the international classification of headache disorders?
- primary headaches: incl. migranes, tension-type headache and trigeminal autonomic cephalagias (cluster headaches) [reccurent, benign and not serious]
- secondary headaches: caused by other conditions
- painful cranial neuropathies (caused by other medical conditions and trauma/nerve damage)
How does headache change with age?
- as you get older, migranes and tension-type headaches become more common
- 25% of people will change their headache type
- half of the people will get worse or improve (1 in 20 will get worse)
What is prevalence of migranes in children?
less than 5% in children under 12
and 10-15% in children over 12
usually occurs in females more after puberty
How do migranes start?
via things that turn the inflammated pathway on:
- aura’’s (cortical spreading od depolarization which triggers sensitization of trigeminal nerves)
- barometric pressure changes can also cause inflammation