Headache Masserano

Question 1

Tension headache

Answer 1

most common kind of headache from sustained contractions of scalp and neck muscles secondary to anxiety or stress
Treatment: NSAIDs, muscle relaxants, SSRIs, TCA

Question 2

Cluster headache

Answer 2

Severe unilateral pain with a sudden onset and offset w/ short duration.
Triggers: alcohol and strong odors
Acute treatment: Sumatriptan

Question 3

Migraine headache

Answer 3

Brain hypersensitivity and a lowered threshold for trigeminal-vascular activation
Symptoms: Moderate to severe disability, photophobia, nausea

Question 4

Cortical spreading depression

Answer 4

Depression of neuronal activity spreads across the cortex.
Responsible for the aura of migraines
Associated with decreased cerebral blood flow

Question 5

Trigeminovascular system

Answer 5

trigeminal nerve fibers are triggered and a vicious circle starts where the nerve terminals release CGRP (vasodilation) and substance P (extraversion)

Question 6

NSAIDs

Answer 6

Abortive treatment for all migraine attacks. Inhibition oof prostaglandin synthesis and prevention of neurogenic inflammation

Question 7

Triptans

Answer 7

Abortive therapy for migraines
Agonists on 5-HT1b and 5HT1d which causes vasoconstriction and inhibit release of neuropeptides preventing neurogenic inflammation

Question 8

Ergot alkaloids

Answer 8

Abortive therapy for migraines
Produce vasoconstriction (5HT1b) and decrease neurogenic inflammation (5HT1d)

Question 9

Preventative therapy considerations

Answer 9

1. Use of abortive medication more than twice per week
2. Their attacks last more than 48 hours
3. Contraindication to or failure of abortive therapy

Question 10

Beta blockers

Answer 10

First line preventive therapy that acts by blocking adrenergic mediated cerebral vasodilation

Question 11

Topiramate

Answer 11

First line preventative therapy that prolongs the inactivation period of Na channels and is an AMPA/kainate antagonist

Question 12

Valproic acid

Answer 12

First line preventative therapy that prolongs the inactivation period of Na channels and reduces Ca currents
Prohibited for females of child bearing age

Question 13

TCAs and SNRIs

Answer 13

Second line preventative therapy that inhibit central cortical depression and sympathetic activity

Question 14

CGRP antibody preventative therapy

Answer 14

Vasodilation is due to CGRP action on vascular smooth muscle and leakage of substance P. Aimovig and Ajovy prevent this