Headaches and Migraines Flashcards
Outline the pathophysiology of tension headaches
- Peripheral sensitisation: Increased tenderness and inflammation of myofacial tissue, lower tolerance to mechanical, thermal and electrical stimuli
- Increased excitability of CNS
- Family history,
nociception of pericranial myofacial tissue
Outline the 3 common symptoms of tension head.
- Tightness across the forehead
- No nausea and vomiting (the differential diagnosis)
- Tenderness in scalp, neck and shoulder
Referral triggers for tension head.
- Neck stiffness
- Severity of headache increases
- suspected cluster headache
- sudden onset
Outline the pharmacological management for tension type headaches
- Paractemol
- NSAIDS
Outline the pathophysiology of migraines
Prodrome
- high conc. of 5 -HT = vaso-constriction of intra-cranial vessels = impaired blood flow
Aura
- Abnormal cortical and brain stem activity
Headache
- low conc. of 5-HT = intracranial vaso-dilation = 20% increase in blood flow to the brain
- unilateral pulsating pain
Post-drome
- Activation of brainstem
- Widespread constriction
Outline the 3 common symptoms of migraines
- Throbbing pulsating pain on one side of the head
- Nausea and/or vomiting
- Sensitivity to light or sound
Triptains, antiemetics and simple non-opoid analgesics are used to treat migraines
Is this a true statement?
YES
How do triptans work
Selectively stimulates 5HT receptors which
1. Constricts blood vessels
2. Inhibits the abnormal activity of trigeminal noniceptors - reduces pain and inflammation
Is photo/phono phobia RARE in a tension type headache?
YES
What are the risk factors for poor prognosis (“an estimation that there is a low chance of recover from a disease”) of tension type headaches?
Poor stress management, anxiety, co-exisiting migraine, sleep problems
Outline non-pharmalogical methods to treat/prevent tension type headaches/migraines - EXACTLY THE SAME DOT POINTS
- regular sleep schedule
- adequate hydration
- avoiding excess simple carbs, eating regular meals to maintain blood sugar concentrations
- Meditation to relieve stress
- biofeedback and cognitive behavioural therapy can help - 30 to 40 minutes of exercise 3 to 4 times a week
Changes in cerebral blood flow causes MIGRAINE PAIN? Is this a true statement
YES
WHEN do the 4 phases of a migraine take place?
- Prodome: hours or days before the migraine attack
- Aura: **Immediately precedes ** the migraine attack (before the headache starts)
- Headache: The actual headache –> pain experienced
- Postdrome: **The end **of the migraine attack
List the acute non-pharmalogical treatment for migraines
- Cold packs over the forehead or back of skull
- Hot packs over the neck or shoulders
- Rest in a dark quiet room
- regular sleep schedule
- 30 to 40 minutes of exercise 3 to 4 times per day
- adequate hydration intake
- avoiding excess simple carbohydrates
- Meditation/biofeedback and cognitive behavioral therapy to manage stress levels
- same for tension headaches except for the first 3
Outline the pharmalogical treatment options for migraines
- Early in the atttack - take simple non-opoid analgesics (e.g. paractemol, aspirin, NSAIDS)
- To treat the nausea and vomiting - take antiemetics (metoclopramide)
- Triptans (taken during the headache phase)
- eleptriptan and sumatriptan: if symptoms reoccur, wait for at least 2 hours before repeating the dose
- naratriptan: wait for at least 4 hours before repeating the dose
