Headaches

Question 1

What is a migraine?

Answer 1

Migraine is a neurological disorder characterized by moderate to severe headache attacks accompanied by symptoms like photophobia, phonophobia, allodynia, and nausea. Migraines are often unilateral, throbbing, and aggravated by physical activity, lasting from 4 to 72 hours.

Question 2

What is migraine aura?

Answer 2

Migraine aura occurs in about a third of migraine patients and involves sensory disturbances, such as flashes of light (spark photopsia) or loss of vision (scotoma). Aura usually lasts around 20 minutes and occurs before the headache

Question 3

How common is migraine, and who is most affected?

Answer 3

Migraine is the third most prevalent medical condition globally, affecting 12% of the population annually. It is more common in women (3:1 ratio) and primarily affects middle-aged individuals, with chronic migraine affecting 2% of the population.

Question 4

What are the diagnostic criteria for migraine

Answer 4

According to the International Classification of Headache Disorders, migraine diagnosis requires moderate to severe headache lasting 4-72 hours, associated with symptoms like photophobia, phonophobia, nausea, or aura, and aggravated by physical activity.

Question 5

What are the proposed mechanisms of migraine?

Answer 5

Migraine mechanisms include atypical pain processing, central sensitization, cortical hyperexcitability, and neurogenic inflammation. Reduced inhibition of pain and abnormal processing in the descending pain modulatory pathway are observed in chronic migraine patients.

Question 6

What is the genetic influence in migraine?

Answer 6

A meta-analysis of genome-wide association studies found significant associations between specific single-nucleotide polymorphisms and migraine risk. These are linked to neuronal excitability and vascular and smooth muscle tissues, indicating multifactorial causes of migraine.

Question 7

How is migraine treated?

Answer 7

Acute treatments include simple analgesics like paracetamol or ibuprofen for mild pain, and triptans for moderate to severe pain. Preventive treatments (e.g., beta-blockers) aim to reduce attack frequency, while relaxation training and cognitive-behavioural therapy are effective non-pharmacological options.

Question 8

What is the prognosis for migraine?

Answer 8

The long-term prognosis for migraine varies. Some patients achieve remission, while others do not. Current research focuses on managing migraine pain as no cure is imminent.

Question 9

What is cluster headache?

Answer 9

Cluster headache is a highly painful condition characterized by severe, unilateral pain in the orbital, supra-orbital, and/or temporal areas. Attacks have a rapid onset and last between 15 and 90 minutes, occurring from once every other day to 8 times per day.

Question 10

How is cluster headache different from migraine

Answer 10

Cluster headache differs from migraine because it is not aggravated by physical activity and does not typically involve nausea. Patients with cluster headaches often become restless or agitated during an attack, unlike migraine patients.

Question 11

What are the typical symptoms of cluster headache?

Answer 11

Cluster headaches are associated with restlessness, agitation, lacrimation (teary eyes), ptosis (drooping eyelid), and a striking rhythmicity, occurring at specific times of the day or year (circadian, circannual).

Question 12

What treatments are available for cluster headaches?

Answer 12

Treatments include preventive medications like calcium channel blockers, nerve blockade for acute relief, and neurostimulation techniques such as occipital nerve stimulation or hypothalamic deep brain stimulation for treatment-resistant cases

Question 13

What is the potential genetic contribution to cluster headaches?

Answer 13

What is the potential genetic contribution to cluster headaches?

Question 14

What is tension-type headache (TTH)

Answer 14

Tension-type headache (TTH) is characterized by bilateral, non-pulsatile head pain described as dull and tightening. Pericranial tenderness and increased head muscle tone are common features.

Question 15

How does TTH differ from migraine?

Answer 15

Unlike migraine, TTH does not involve nausea and is not aggravated by physical activity. TTH pain is bilateral, while migraine is typically unilateral

Question 16

What is the prevalence of Tension-type headache

Answer 16

TTH is very common, with a lifetime prevalence of over 60%. It affects people mainly between 20-39 years old, with a slight female predominance (2:3 ratio).

Question 17

How is tension-type headache treated?

Answer 17

TTH usually responds to simple analgesics, with less evidence for preventive treatments. Most patients self-medicate at home to manage symptoms.

Question 18

What is the most common trigger for tension-type headache?

Answer 18

Psychological stress is the most common trigger for TTH. Central sensitization has also been proposed as a potential mechanism.

Question 19

What are the differences in prevalence and severity between migraine, cluster headache and TTH?

Answer 19

Migraine affects 12% of the population and is more common in women. Cluster headaches are rare but extremely painful, occurring more frequently in males. TTH has a high prevalence (>60%) and is often less severe than migraine or cluster headaches.

Question 20

What is the typical age of onset for migraine, cluster headache and TTH?

Answer 20

Migraine often affects people in middle age (40-45 for females, 25-55 for males). Cluster headache usually starts between 20 and 40 years, while TTH onset is between 20-30 years, peaking at 30-39 years.

Question 21

What are the common autonomic symptoms associated with cluster headache?

Answer 21

Autonomic symptoms of cluster headache include lacrimation, ptosis, restlessness, and agitation. These symptoms are not typically present in migraine or TTH.

Question 22

What role does central sensitisation play in headaches?

Answer 22

Central sensitization is involved in the mechanisms of both migraine and tension-type headache, contributing to abnormal pain processing and increased sensitivity to stimuli.

Question 23

What are neurostimulation techniques used for treating cluster headaches?

Answer 23

Neurostimulation techniques for cluster headache include occipital nerve stimulation and hypothalamic deep brain stimulation, which can be effective for patients resistant to other treatments.

Question 24

How does the onset and duration of cluster headaches compare to migraines?

Answer 24

Cluster headaches have a rapid onset and last 15-90 minutes, while migraines develop more gradually and can last from 4 to 72 hours. Cluster headaches also occur multiple times per day, unlike migraines

Question 25

What are triptans, and how are they used in headache treatment?

Answer 25

Triptans are highly selective serotonin receptor agonists used for moderate to severe migraine pain. They are effective for treating acute attacks but are not suitable for all patients.

Question 26

What are some non-pharmacological treatments for migraine?

Answer 26

Non-pharmacological treatments for migraine include relaxation training and cognitive-behavioral therapy, which have efficacy comparable to preventive medications. These are especially recommended for vulnerable groups like pregnant or breastfeeding women.

Question 27

What is the significance of autonomic symptoms diagnosing cluster headache?

Answer 27

The presence of autonomic symptoms like lacrimation and ptosis helps distinguish cluster headache from migraine and TTH, as these symptoms are unique to cluster headache.