Headaches Flashcards
Types of headaches that are primary or benign
Tension
Cluster
Migraine
Secondary or malignant headaches
hangover (dehydration)
tumor
meningitis
Tension headaches- Dx
Requires 2 or more of the following tightness in band like pattern around the head bilateral mod to severe pain no change w/ activity no sensitivity to light or sound No N/V before or during HA
Tension HA- Tx
analgesics- ASA, APAP
Amitryptylline can be used cautiously
CCB
What type of HA
44 yr old male smoker w/ recurrent HA w/ inc frequency- now are 2 episodes/ day for 6 months.
HA last between 2 and 4 hours, pain is excruciating.
R eye is red and tears up, nostril is swollen and congested.
During the attack he become severely agitated.
LP, physical, and neurologic exam are all normal.
Cluster HA
normally occur at specific time every day
Cluster HA tx
subcutaneous sumatriptan
oxygen mask
Migraine HA- stages
Premonitory (prodome), aura, HA, and postdrome
Migraine HA prodrome
occurs in 60% of pts
last 24-48 hrs before the migraine.
altered mood, irritability, depression, euphoria, and yawning
Migraine- Aura
experienced in 25% of pts
acute focal neurological phenomena
usually visual but can be sensory, verbal, or motor
Normally lasts less than 1 hr bfr the migraine, but it can occur simultaneously
Migraine- HA
this is the migraine event
characterized as unilateral and throbbing
Cutaneous alydonia
Migraine- Postdrome
hangover feeling with mood changes and fatigue, weakness, and head movement= pain
Migraine HA epidemiology
Women> males
ages 30-39
Cutaneous Allydonia
pain with normal touching of the skin ie brushing hair, shaving, and contact lenses.
Normally occurs with the migrane but can occur w/o one
Types of migraines
Classic- migraine w/ Aura Common- migraine w/o aura basilar occular Aura w/o H/A migraine w/ acute onset of aura migranous vertigo opthalmoplegic migraine menstral migraine Familial Hemiplagic migraine
Pathophysiology of Migraine
cerebral artery dilation
dec 5HT
Aura is caused by vasoconstriction
Role of trigeminal nervous system in migraine
Trigeminovacular system and ganglia are stimulated –> vasoactive peptide release (substance P, neurokinin A, Calcium gene related peptide) –> inflammation –> sensitization
Cortical spreading of depression for aura
metalloprotease up-regulation and activation inc permeability of BBB, inflammation of meninges
What heart defects are involved in migraines
R –> L shunts
PFO, ASD, AVM
Genetics of the trigeminal ganglia and migraine
KCNK18 codes for TRESK a K channel in the trigeminal ganglia.
mutations that cause down regulation of KCNK 18 and therefore TRESK retult in change in neuron excitability.
Genetics of Familial Hemiplagic migraine Genetics
3 genes= 3 types of FHM:
CACNAIA- FHM 1
ATPIA2- FHM 2
SCN- 1A- FHM 3
precipitating factors of migraines
stress hormones not eating sleep disturbances obesity
Dx criteria and common features for Classic Migraine
at least 2 migraine attacks with aura (15-60 min before the migraine). Aura is fuly reversible visual, sensory
symptoms are not part of something else
Common features
HA is of variable duration
visual defects or hemisensory disturbances
often have: nausea, vomiting, photophobia, phonophobia
Dx criteria and common features for common migraine
2 of more of the following- unilateral, pulsatile, moderate to severe intensity, aggrevated by routine
at least photophobia, phonophobia, N/V
at least 5 attacks that fully meet this criteria that are not a part of another condition
HA may last 4 - 72 hours
Need to rule out Tension HA
Familial Hemiplagic Migraine- diagnostic criteria
Aura is fully reversible muscle weakness
at least a 1st or 2nd degree relative with it, but can also have it without this
Migraine HA- tx
triptans- 5HT agonists Egot derivatives benzos NSAIDs telcangespant antihypertensives TCAs anti convulsants
Complications of migraine
chronic migraine: at least 15 days/ month for 3 months
status migranosus- lasts for over 72 hrs
persisten aura w/o infarction- 1 week w/o infarction
Migranous infraction- aura symptoms assoc with ischemic brain lesion, visible on MIR, deficits last over 1 hr
Migraine induced seizure
Menstral Migraine
migraine that occurs 2 days before onset of menses
may have the migraine at other times
tx doesn’t change but can use mini pophylaxis 1-2 days bfr or use hormone preventative tx
