Headache Part 2 Flashcards
What are the symptoms of migraine disorder?
- Tendency to repeated attacks
- Triggers
- easily hung-over
- visual vertigo
- motion sickness
What is prodrome migraine phase?
- Changes in mood
- urination
- fluid retention
- food craving
- yawning
What is aura migraine phase?
- Visual
- Sensory (numbness/paraesthesia)
- weakness
- speech arrest
What is the headache migraine phase?
- Head and body pain
- nausea
- photophobia
What is the resolution migraine phase?
rest and sleep
What is the recovery migraine phase?
- mood disturbed
- food intolerance
- feeling hungover
48 hour or so
What are the treatments for an acute attack of migraine?
- Aspirin/ibuprofen (Non-steroidals)
- paracetamol
- metoclopramide (anti-emetic) - gastric perisis in migraine so difficulty with nausea, stimulates peristalsis
- Soluble preparations to aid absorption - Triptans-tablets, melts, nasal sprays, s/c injections (vasoconstrictors) (treat only headache not the auras). Synergise with NSAIDS (take together)
- A short nap
- TMS-interrupts complex networks that trigger and perpetuate migraine, which is caused by spreading electrical depression across the cerebral cortex
What do you have to be caution with migraine treatment?
Opiates-caution! Analgesic abuse potential
What are lifestyle issues with people with migraine?
- Migraineurs have sensitive heads even in between attacks
- Over-react to any sort of stimulation
- Can’t ignore the world around them, it overstimulates their brains
What are the triggers with migraine?
- dietary, environmental, hormonal, weather, dehydration, stress
- Drink 2 litres water/day
- Avoid caffeinated drinks
- Don’t skip meals
- Fresh food
- Avoid ready meals and take-aways - Don’t oversleep or have late nights
- Electronics downstairs - Analgesic abuse
What are some over the counter prophylaxis options for migraines? For chronic migraines (more than 14 a month)?
- feverfew
- coenzyme Q10
- riboflavin
- magnesium
- EPO
- nicotinamide
What are some other prophylaxis option for migraines?
- Tricyclic antidepressants (TCAs): amitriptyline 7pm
- Beta-blockers - Propranolol, Atenolol (but can drop BP and pulse and lots of people can’t take BB)
- Serotonin antagonists: pizotifen (can use on children) very effective, methysergide
- Calcium channel blockers: flunarazine, verapamil
- Anticonvulsants: valproate, topiramate, gabapentin (can’t get preggers as dangerous with)
- Lots of different problems for reasons why migraine hence so many different drugs that may or may not work for you
What is erenumab?
Injectable drug erenumab (Aimovig) monthly
Is erenumab effective?
cut number of days people had migraines from an average of 8 a month to between 4 and 5 a month
How are monoclonal antibody erenumab used in treatment of migraines?
- disables calcitonin gene-related peptide or its receptor (CGRP mAbs)
- Used for episodic migraine, chronic migraine, or cluster headache.
What are the symptoms of tension type of headache?
Tight muscles around head and neck bilaterally, as though head is in a vice
What is the treatment for tension type of headache?
- NSAID’s preferred:
-Ibuprofen Naproxen, Diclofenac - Paracetamol
- Tricyclic antidepressants:-
•Amitriptyline 50-75mg daily
•30-60% derive some symptomatic relief
-Biofeedback and relaxation unproven
What is less effective for tension type of headache?
-SSRIs
What is a cluster headache?
Severe unilateral pain lasting 15-180 minutes untreated
What is a cluster headache classified as?
a trigeminal autonomic cephalgia
What is there at least one of ipsilaterally in a cluster headache?
- Conjunctival redness and/or lacrimation
- Nasal congestion and/or rhinorrhoea
- Eyelid oedema
What are other symptoms of cluster headaches?
- Forehead and facial sweating
- Miosis and/or ptosis
- A sense of restlessness or agitation
- Frequency between one on alternate days to 8 per day.
- Not associated with a brain lesion on MRI
What is the acute treatment of a cluster headache? What does oxygen do?
- Inhaled oxygen.
- Oxygen inhibits neuronal activation in the trigeminocervical complex - Subcutaneous injection or Nasal Sumatriptan
What preventative medicine can you take for cluster headache?
- Verapamil
- Prednisolone
- Lithium
- Valproate
- Gabapentin
- Topiramate
- Pizotifen
(Short course of steroids)
