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
When should be triptans be taken?
When the headache starts to develop and not during aura or severe headache
One should not take ergotamiens for 24 hours before or after taking a triptan. Is this a true statement
This is a practise point for migraine medications
YES
Outline the efficacy and onset of action of naratriptan compared to sumatriptan (pharmacist only medication - sold under the brand name - SUMATRIPTAN WAGNER HEALTH - GENERAL AND IMIGRAINE - ORIGINAL brand)
- Slower onset of action, less effective and fewer side effects
- approx 2 hours
- Oral dose
