headache: migraine, cluster and tension Flashcards
what is migraine?
a headache disorder, with repeated attacks of fairly stereotyped headaches
features: repeated attacks triggered easily hung-over visual vertigo hemi cranial! (not the same as unilateral) motion sickness
what are the 3 forms of migraine attacks?
pain
focal symptoms
pain and focal symptoms
what are the phases of a migraine?
prodrome:
changes in mood, urination, fluid retention, food craving, yawning
aura:
not always.
visual, sensory (paraesthesia), weakness, speech arrest
headache:
head and body pain, affects half the head, nausea, vomiting, photo and phonophobia
resolution:
less pain, almost comforting, allows for rest and sleep
recovery:
mood disturbed, food intolerance, feeling hungover
over 48 hours or so
simply, what are the phases of a migraine?
prodrome aura headache resolution recovery
what is a migraine aura?
can have positive or negative symptoms. both together is characteristic of a migraine aura
negative:
blackness, loss of vision
positive:
flashes, and zig zags
for some people they will have expanding C’s. others will have elemental visual disturbance, which causes movement and expansion of the aura
how are acute migraines treated?
aspirin/ibuprofen (non steroidals) and paracetamol
anti emetics
(soluble preparations to aid absorption)
triptans (pain killers just for migraine headaches) (can come in many forms) (they are vasoconstrictors, so have to be careful) (always synergise with NSAIDS)
you should take the medication as soon as you think one is coming. they have no effect later
opiates (careful)
a short nap
TMS (transcranial magnetic stimulation) - interrupts complex networks that trigger and perpetuate migraine
what is the mechanism of migraines? (simple)
spreading electrical depression across the cerebral cortex
what are lifestyle treatments of migraine?
people who get migraines have a genetic predisposition
they generally always have sensitive heads. they overreact to any sort of stimulation, so may be easily triggered
LOOK FOR TRIGGERS AND AVOID THEM
dietary, environmental, hormonal, weather, dehydration, stress
hydrate, avoid caffeine, dont skip meals (to avoid hypoglycaemia), avoid late nights and electronics, dont oversleep, avoid alcohol, chocolate, cheese
watch out for analgesic abuse
what is prophylaxis for migraines?
over the counter preparations: feverfew, coenzyme Q10, riboflavin, magnesium, EPO, nicotinamide
tricyclic antidepressants:
amitriptyline
beta blockers:
propanolol, atenolol
serotonin antagonists: pizotifen (very effective)
calcium channel blockers
anticonvulsants
botox (paralyses muscles, crown of thorns)
greater occipital nerve blocks (injection)
suppress ovulation (Progesterone only pill or implant) (oestrogen may cause headaches)
these all have nothing in common but they all may help with migraine. many genes (heterogenic) may contribute to migraines, so different people may like different ones
what is chronic migraines?
more than 14 migraines a month
they need migraine prophylaxis as well as other treatments
what is erenumab?
an injectable drug (aimovig)
given monthly
it cuts the number of migraines people have a month from an average of 8 down to 4
also severity too
it is a monoclonal antibody:
it disables calcitonin gene-related peptide or its receptor (CGRP mAbs)
can be used to treat episodic migraine, chronic migraine or cluster headache
what is a tension headache?
due to tight muscles around head and neck bilaterally, as though head is in a vice
happens when stressed, busy, not winning at life
how are tension headaches treated?
NSAIDs preferred (ibuprofen, naproxen)
paracetamol
tricyclic antidepressants - amitriptyline ( if you get them a lot)
SSRIs probably less effective
biofeedback and relaxation are unproven
what is a cluster headache?
severe unilateral (but not hemi cranial like migraine) pain lasts 15-180 mins untreated
classified as a trigeminal autonomic cephalgia
pain is mainly in the region of the first division (phantom of the opera mask)
they occur from once every other day, to eight times a day
not associated with a brain lesion on MRI
what are the symptoms of a cluster headache?
unilateral (phantom of the opera mask) headache
accompanied by at least one, ipsilateral:
conjunctival redness and/or lacrimation
nasal congestion or rhinorrhoea
eyelid oedema
forehead and facial sweating
miosis and/or ptosis
a sense of restlessness or agitation
(notice most of these are autonomic symptoms)
