HEADACHES Flashcards
headache
pain or discomfort located in the head or face area
vary greatly in pain location, pain intensity, and frequency
nociceptors
pain is experienced when unpleasant stimuli activate sensory nerve fibres called nociceptors in skin, muscles, joints and some organs - these transmit pain signals from the periphery to the brain
where are nociceptors found?
found in layers of tissue known as the dura and pia, and chemicals released from blood vessels near the dura and pia can activate nociceptors, resulting in headache
primary headache
the headache itself is the main medical problem
primary headache triggers
medications
dehydration
changing levels of hormones
cluster headache
usually occur in a series that may last weeks or months, and the headache series may return every year or two
common symptoms of cluster headaches
- severe pain on one side of the head, usually behind one eye
- the eye that is affected may be red and watery with a droopy lid and small pupil
- swelling of the eyelid
- runny nose or congestion
- swelling of the forehead
secondary headache
symptom of a disease that can activate the pain-sensitive nerves of the head.
danger symptoms that could be a clot (stroke) or tumour
- tension headache
- trauma/injury to neck or head
- cerebral vascular disorders (thunderclap)
- infection (ear/eye/nose/tooth)
- secondary to facial pain (sinus/mouth/eyes)
- psychiatric disorders (panic attacks/disorders)
- ADRs - rebound headache
- dehydration - hangover
- referred pain
rebound headache
- overuse of painkillers
- caffeine heavily implicated headaches may be caused by conditions such as disorders of the neck, eyes, brain, jaw or teeth
who are migraines most likely to affect
- rare in U12
- more common in women
symptoms of migraine without aura (primary headache)
- attacks lasting 4-72 hours
- unilateral location
- pulsating quality
- moderate or severe pain intensity
- aggravation by or causing avoidance of routine physical activity
- nausea and/or vomiting
- photophobia
- phonophobia
migraine triggers
- stress and other emotions
- biological and environmental conditions, such as hormonal shifts or exposure to light and smells
- fatigue and changes to sleep pattern
- glaring or flickering lights
- weather changes
- certain foods and drinks
why are migraines considered vascular headaches
increased blood flow can also trigger a migraine
migraine
- throbbing with hypersensitivity to light, sound and touch
- usually frontotemporal
- in children and adolescents often more bilateral
- can be associated with cranial autonomic symptoms and symptoms of cutaneous allodynia
- migraine without aura has a menstrual relationship (5-HT/oestrogen levels change)
aura symptoms
- visual
- sensory
- speech and/or language
- motor
- brainstem
- retinal
migraine with aura symptoms
- aura symptom spreads gradually over 5 minutes or more
- 2 or more symptoms occur in succession
- each individual aura symptom lasts 5-60 min
- 1 or more aura symptom is unilateral
- 1 or more aura symptom is positive
- aura accompanied or followed in <60 min by headache
treatment of primary headaches
paracetamol
ibuprofen
codeine
bulizine
triptans
propanolol
pizotifen
paracetamol moa
acts in inhibition of prostaglandin production in pain pathway
also in activation of descending serotonergic pathways
ibuprofen moa
act on COX-1 and COX-2 receptors to inhibit production of prostaglandins in pain pathway
codeine moa
acts centrally, has limited effectiveness on its own and works better in combination products
buclizine moa
antihistamine with anti-emetic properties, also sedating (in migraleve pink)
triptans moa
sumatriptan, zolmitriptan, rizatriptan
selective 5-HT serotonin receptor agonists with high affinity for 5-HT1B and 5-HT1D receptors
stimulation of the 5-HT1B receptors on smooth muscle cells of blood vessels causes cranial vasoconstriction
propanolol moa
beta blocker reduces blood flow
interacts with rizatriptan
pizotifen moa
acts on serotonin, histamine and tryptamine reducing blood flow and alters pain threshold in migraine
what aches when you have a secondary headache
- a network of nerves that extends over the scalp
- certain nerves in the face, mouth, and throat
- muscles of the head, neck and shoulders
- blood vessels found along the surface and at the base of the brain (contain delicate nerve fibres)
tension headache
most common
stress and muscle tension are often factors in tension-type headaches
common features of a tension headache
- slow onset
- bilateral
- pain is dull or feels like a band around the head
- pain may involve the back (posterior) part of the head or neck
- pain is mild to moderate but not severe
dangerous causes of a headache
blood clots
thunderclap
brain tumour
thunderclap
rapid onset
severe
e.g. haemorrhagic stroke or other underlying vascular problem
secondary headache treatment options (7)
NSAIDs (paracetamol, ibuprofen, codeine)
muscle relaxants (diazepam)
anti-bacterial
decongestants (pseudoephedrine, xylometazoline)
anxiolytics
amitriptyline
gabapentin/pregabalin/carbamazepine
non-pharmacological interventions for headaches
- plenty of rest
- plenty of water
- relax (stress can make headaches worse)
- exercise
- avoid triggers
