Headaches

Question 1

migraine

1. patient appearance
2. duration

Answer 1

1. prefers rest in dark quiet room (aggravated by physical activity)
2. 4-72 hrs

Question 2

tension headache

1. patient appearance
2. duration
3. Tx

Answer 2

1. active or may rest
2. variable
3. NSAIDs (self medicate)

Question 3

cluster headache

1. patient appearance
2. duration
3. Tx
4. who
5. cause

Answer 3

1. active
2. less than 3 hrs
3. nasal or SC triptans or ergots AND burst and taper steroid (prednisone)
4. MALE, SMOKER
5. VASODILATION, activation of CN VII, trigeminovascular and superior hypothalamic activation

Question 4

Pathophys of migraine

Answer 4

1. hyper excitability increases brain stem response to triggers
2. release of NT
3. activation of trigeminal nucleus

Question 5

migraine NT

Answer 5

5-HT
NE
DA
GABA
glutamate
NO
CGRP
Substance P
Estrogen

Question 6

How does activation of trigeminal nucleus lead to

1. throbbing
2. N/V
3. head pain
4. hyper-sensitivity
5. muscle spasm

Answer 6

1. dilation of meningeal blood vessels
2. activation of area postrema
3. activation of cortex and thalamus
4. activation of hypothalamus
5. activation of cervical trigeminal system