headache W1 Flashcards
2 headache categories?
primary headache
secondary headache (due to underlying disorder)
types of primary headache?
tension type headache
migraine
trigeminal autonomic cephalgias including cluster headache
other including primary stabbing headache and benign exertional headaches
secondary headache causes?
infection (eg meningitis, covid)
vascular (eg stroke, aneurysmal bleed, giant cell arteritis)
raised ICP (eg trauma, brain tumour)
medication side effects
tension type headache - features?
whole head
dull, pressing
mild-moderate severity
usually no associated features, rather non-specific
only considered a disease if arise spontaneously and frequently
tension type headache treatment
acutely NSAIDs
preventative tricyclic antidepressant
trigeminal autonomic cephalgias - description?
activation of trigeminal and autonomic pathways presenting as unilateral headache attacks with ipsilateral autonomic features, often circadian
(frequent attacks for a while, goes away for a yr then comes back)
ipsilateral autonomic features in trigeminal autonomic cephalgias?
red eye
ptosis
lacrimation
rhinorrhea
what are trigeminal autonomic cephalgias distinguished by?
duration and frequency
most common type of trigeminal autonomic cephalgias? who do these affect most commonly?
cluster headaches
middle ages men
less common types of trigeminal autonomic cephalgias?
paroxysmal hemicrania and hemicrania continua
types of trigeminal autonomic cephalgias?
cluster headache
paroxysmal hemicrania and hemicrania continua
SUNCT and SUNA
what does SUNCT stand for?
short lasting unilateral neuralgiform headache with conjunctival injection and tearing
what does SUNA stand for?
short lasting unilateral neuralgiform headache and autonomic features
characteristics of a migrane?
often one sided, can be whole head
severe pulsating/throbbing
4-72 hours
lots of associated features
associated features of migrane?
photophobia (light), phonophobia (sound), nausea/vomiting, desire to lie still, exacerbated by movement
migraine with aura?
occurs before headache, spreads over time, 90% visual, can affect sensation (normally tingling) and speech. can have aura without headache
what can aura without headache be mistaken for?
TIA
prodromal and postdromal features of migraine?
tiredness, irritability, yawning, poor concentration
chronic migraine vs episodic migraine?
chronic = headache ≥15 days/month for ≥3 months, migraine features ≥8 days/month
what is chronic migraine often associated with
analgesia overuse
migraine epidemiology?
post puberty normally, 3F:1M
peaks 35-45 yrs
genetic factors can increase susceptibility by small degree
hormonal factors
environmental triggers
hormonal factors in migraine epidemiology?
gender, puberty, periods, pregnancy, menopause, COCP
environmental triggers for migrane
emotional stress, change in sleep pattern, certain foods, weather change
pathophysiology of migraine?
involves activation and sensitization of trigeminovascular pathways
disorder of sensory processing and altered brain excitability
migraine acute treatment?
aspirin (ideally soluble, high dose 600-900mg)
NSAIDs
triptans (gold standard)
avoid analgesia overdose
lifestyle (hydration, sleep, fresh air, exercise, screen breaks)
migraine preventative treatments - drug examples?
propranolol (beta blocker)
pizotifen
amitriptyline
candesartan
topiramate
flunarizine
riboflavin
botulinum injections (botox)
new migraine drugs?
CGRP - calcitonin gene related peptide drugs
neuropeptide in trigeminal ganglion neurones. release causes cascade resulting in sensitization of trigeminal nerves
key role in migraine pain pathways through trigeminovascular system
very expensive!
