Headaches Flashcards
1
Q
Types of headaches
A
- Primary: not caused by other diseases
- secondary: results from assoicated disease or trauma
2
Q
secondary causes of headaches
A
- head and neck trauma (cervicogenic)
- infection
- vascularr
- medications
- disorder homeostasis
- psychiatric disorders
3
Q
Mirgraines
3 key features
A
- inherited tendency: tend to run in the family
- sensitive to endogenous and exogenous tiggers
- stereotypical attack phenotype
4
Q
Migraines
A
- recurrent episodic neuromuscular disorders of the brain
- impact structures in the brain stem and diecenphalan
5
Q
Mirgraines: abnormal perception of the normal stimulus
A
- pain/allodynia
- sensitivity to light, sound,
- cognitive symptoms: brain fog, visual and hearing changes
- autonomic symptoms: HR, BP, RR, nausea, vomitting
6
Q
Migraines
Variations
A
- with or without aura;
- familial hemiplegic,
- basilar,
- childhood;
- abdominal
- retinal
- opthalmoplegic
- retinal chronic
- aura: depression, irritability, loss of appetite, visual aura
7
Q
Mirgraines
Pathogenesis
A
- Central sensitization
- peripheral sensitization: occurs within the trigeminal ganglion (opthalmic division) and upper cervical dorsal roots
- Neurotransmitter substance: regulate tone in cranial blood vessels;
- serotonin activate pain receptors
- endocrine connections: menstrual migraines, estrogen drops, prostaglandins
8
Q
Trigeminal vascular theory of migraines
A
- Thalamic neurons prolong the effects of the pain stimulus that come from the trigeminal vascular systems
- Stimulation of the trigeminal nerve causes vascular dilatation, and neurogenic inflammation also contributes to migraine symptoms
- retinothalamic pain pathway
- olfactory input stimulates limbic structures and pons
9
Q
Mirgraines
Diagnosis
A
- History
- normal neuro exam
- often undiagnosed
- differentiate with tension or sinue headaches
- MIDAS: migraine disability assessment questionaire measures the impact of headaches
10
Q
mirgraines
treatment
A
- if you can figure out where they are starting then you can get specific
- direct at implicated system
- avoid triggers
- quiet, dark place
- medication
11
Q
Mirgraines
Medications
A
- triptans: gold standard
- calcitonin Generelated peptide receptor antagonist
- antiepileptics - gabapentin, valproate and topiramate
- botox
- beta blockers
- vasoconstrictors
- NSAIDs
12
Q
Tension type headaches
A
- Most common type of headache
- episodic or chronic
- pericranial myofascial nocicpetion
- neck musculature becomes firm without increased firing
13
Q
Tension type headaches
Episodic or chronic
A
- chronic: genetic and environmental effect
- episodic: more environmental
14
Q
tension-type head
Pericranial myofascial nociception
A
- Peripheral sensory afferent neurons become hypersensitized possibly by serotonin and bradykinin
- once central afferents get involved transitions to chronic
15
Q
tension-type headaches
Diagnosis
A
- Requires exclusion of other causes
- palpation of temporal, lateral pterygoid, masseter, SCM, and trapezius muscles specifically
16
Q
tension-type headaches
Treatments
A
- pharmacological
- behavioral treatment: give relaxation techniques with behavioral
- PT: tigger points in that area = decrease tension with STM
17
Q
Cluster headache
characteristics
A
- excruciating sudden pain – unilateral; one eye, frontotemporal region
- autonomic symptoms: on the opposite side form the pain (typically) (photophobia, tearing, and nasal congestions)
- most occur evening to early morning with peak occurence midnight - 3 am
- predominantly in men b/w 27-30
- second hand smoke trigger
- studies showing genetic predisposition
- links to sleep and arousal mechanisms
18
Q
Cluster headahces
Diagnosis
A
- Often delayed: unable to get imaging, labs and etc at the time of the episode
- Diagnostic criteria are strict unilaterally
- severe intensity
- orbital localization
- and short duration
19
Q
Cluster headaches
Differential diagnosis
A
- mirgraine
- trigeminal neuralgia
- chronic paroxysmal hemicrania
- pericarotid syndrome
- sinusitis and glaucoma
- paroxysmal hemicrania, trigeminal neuralgia, and temporal arteritis have similar symptoms but not episodic
20
Q
Cluster headaches
Treatment
A
- acute attack: oxygen, subcutaneous sumatriptan
- prophylactic: varapmil
- surgical procedures: radio surgeries directed toward the sensory trigeminal nerve to cut fibers so they are not getting input
21
Q
Secondary headaches
A
- attributed to neck disorder
- post-traumic headaches
- attributed to psychiatric disorders - medication overdose
- giant cell arteritis
- rhinosinusitis
- postdural puncture headache
- trigeminal neuralgia
22
Q
Postdural puncture headahce
A
- seen in acute care when dura is punctured (nerve block/epidural)
- lose spinal fluid and the brain will not float
- intenisty is tremendous and gets worse with sitting and standing up
23
Q
look at tables at the end of the slideshow
A
