headaches Flashcards
***headache “red flags” (5-6)
- wakes from sleep
- constant/worsening over months
- sudden onset
- SEVERE! (thunderclap)
- meningismus (nuchal rugidity, fever)
- neuro deficits
- trauma
- papilledema
T/F - papilledema is headache flag
*common in _____ and ____
TRUE
-tumor and idiopathic intracranial hypertension
are following migraine symptoms related to hypothalamus / BS / cortex or limbic system:
- -muscle tenderness, neck stiffness
- -sensitivity to light/sound/smell
- -depression/anehedonia
- -fatigue/irritability/yawning
BS / cortex / limbic system / hypothalamus
Migraine triggers (3-4)
- food (wine, cheese)
- inc stress
- weather?
- light/smell
- dec sleep
***trigeminal vascular system involved in ______(type of headaches)
-whats its role?
- TVS = final common pathway in MIGRAINE headaches (assoc w/ hypothalamus)
- leads to PAIN!! (hyptohalamus directly or indirectly triggers THALAMUS leading to pain)
- pathophys behind “aura” in migraines
- cortical spreading depression on LEFT will lead to aura on _____
- CORTICAL SPREADING DEPRESSION starting in trigeminal nucleus »_space; dorsal/rostal pons»_space; pulvinar»_space; occipital cortex
- CSD = neuronal activity depression spreads backwards through brain»_space; lower state of bloodflow»_space; aura (visual/sensory changes)
- CSD on L = Aura on R
–migraine triggers activates _______ (part of brain)»_space; send projections to SSN which triggers sphenopalantine ganglion to release substances»_space; causes vaso_____(Dilation / constriction) in meninges innervated by ______(cranial nerve)»_space; activates _____ that leads to pain
*summary = starts in ___ which activates ____ and pain
- HYPOTHALAMUS»_space; SSN»_space; triggers release of Ach/Vip/NO from sphenopalantine ganglion»_space; causes VASODILATION in meninges (innervated by trigeminal nerve)»_space; afferents into trigeminal»_space; spinal nucleus of CNV»_space; thalamus»_space; PAIN
- Hypothalamus»_space; thalamus
In migraines, peripheral sensitization pathway activated by CN ____ afferents in meninges
*____(peripheral or central) sensitization leads to _____(p/c) senitization
- CN5 - picks of sensory info meninges (in PNS)
* peripheral sensitization leads to central sensitization (in CNS, can increase frequency of migraines) if not stopped
cutaneous allodynia
- def
- hall mark of ____(peripheral or central) sensitization
- clue that migraine is _____(new / chronic)
- rub nonpainful stimulus on skin and is painful (ex - over orbit)
- hallmark of CENTRAL SENSITZATION
- CHRONIC
common vs classic migraine
-which is cortical spreading depression involved in?
- common = no aura
- classic =
- **common migraine criteria
- time
- chx / symptoms
*difference w/ classical migraine?
- 4-72 hours
- at least 2 of following chx = unilaterlal, pulsating, moderate-severe, aggrevated by physical activity
- at least 1 of = nausea/vomitting or photophobia
*same as classical exceept no aura
migraine? 18 yo with headaches once amonth around period, moderate-severe, pulsating, lasting 5-6 hours that gets worse, no nausea/vomiting and no photophobia
NO! need either n/v or photophobia
migraine type:
- aura
- no aura
- dysarthria, dysphagia, hemiparesis
- ataxia w/out sensory
- ataxia w/ sensory
T/F - dysarthria and fatigue can be feature of ALL
- classical
- common
- hemiplagic
- vestibular
- basilar
TRUE!
- **describe abortive vs. prophylatic strategies for migraine therapies
- what are major class of abortive medicaitons?
- how do they work?
- ABORTIVE = TRIPTANS! (serotonin agonists (ex - 5HT1b receptor in SM»_space; vasoCONSTRICTION)
- PRO = use abortive mediatication before it happens (ex - day before periods, or before eating give long acting triptan)
TRIPTANS
- are serotonin ____(agonist or antagonist)
- T/F - far more successful if used at first signs
- serotonin agonists
- TRUE
5H1b receptor in SM causes vaso_______(constriction/dilation)
-use agonist or antagonist for migraine rx?
- vasoconstriction
- so agonists (inc constriction) rx for migraines
Vitamin prolphylaxis for migraines?
- Vit B2
- Mg?
*esp good for pregnant woman (since other rx are contraindicated)
Frovatriptan (Frova ®) and naratriptan (Amerge®) have ______(longer or shorter) 1/2 life than others (sumatriptan, rizatriptan, etc)
-used as abortive or prophylactive abortion (ie, before period)
- longer
- prophylaxis
AED prophylaxis for migraines (2)
- valproic acid (contraindicated for pregnancy)
- topiramate/gabapentin (enhance GABA)
- which can be used for prophylaxis for migraine
- tricyclic antidepressants
- SSRI
- SNRI
- antihypertensives
- SNRI YES! (selective norepinephrine reuptake) but NOT SSRI (at least no evidence)
- antidepressants and antihypertensives YES!
T/F - chronic sinusitis is not validated as a cause of headache
**T/F - majority of ppl with headaches associated with sinus symptoms are MIGRAINES **
- TRUE ?
- TRUE !!
rhinosinusitis headache def?
- frontal headache w/ pain in face/ears/teeth (headache/pain develop sinumltaenosu w/onset of sinus symptoms
- must have evidence of congestion / purulence / fever
NOTE! >90% of these patients meet dx for MIGRAINE
- **medication overuse headache
- headache present > ___days / month
- most be overusing meds for > ___ months
- MUST MUST MUST be OFF of meeds >____ months in order to dx
- headache present > __15_days / month
- most be overusing meds for > __3__ months
- MUST MUST MUST be OFF of meeds >___2___months in order to dx
- **describe trigeminal autonomic cephalgies
- 4 types
- shared chx
- cluster headaches (SEVEREEE unilateral pain w/ lacrimation/congestion/sweating/miosis/ptosis)
- chronic parozysmal hemicrania
- hemicrania continua (ICE PICK IN EYE)
- SUNCT
TRIGEM AUTO CEPH changes = lacrimation, sweatig, misosi, ptosis etc
***different areas but HYPOTHALAMUS is activated in all
