Headaches and migraines Flashcards
What is the difference between primary and secondary headaches
Primary= diagnosis made in the absence of physical signs Secondary= diagnosis is made in the presence of physical signs
3 main types of headaches
Tension headache
Migraine
Cluster headache
What % of all headaches are tension headaches
80
What % of headaches are migraines
15
What % of headaches are cluster headaches
0.2-0.3%
Which headache affects men more than women
Cluster
When is a headache described as normal
When symptoms disappear once stimulus ire removed
Symptoms of a cluster headache
Pain comes in clusters lasting 6-8 weeks
Severe pain behind eyes
Unilateral rhinorrhoea
3 treatment options for cluster headaches
High flow oxygen for vasoconstriction
Triptans used to vasoconstrict
Verapamil
How many attacks must a person have for it to count as migraine? How long must they last for?
5 in a lifetime
4-72 hours
2 of which 4 characteristics must be seen to be categorised as an migraine
Unilateral pain
Pulsating
Moderate- severe pain
Aggravated by walking
1 of 2 symptoms must be seen to be categorised as a migraine
NIV
Photophobia and phonophobia
What is meant by the threshold of a headache
What stimulia can a person withstand before getting a migrain
What molecule is released in the early stages of a migraine
5-HT
What is the impact of releasing 5-HT in early stages
Constriction of dilated blood vessels
Dilations of constricted blood vessels
What are triptans
5-HT1D/B agonist
Name a prophylactic drug used to treat migraine
Methysergide
5-HT2b antagonist
What are the 5 stages of a migraine
1) Premonitory phase
2) Aura
3) Headaches
4) Resolution
5) Recovery
What happens in the premonitory phase of a migraine?
Cravings
Yawning
Fluid retention
Neck pain
Which part of the brain is affected in the premonitory phase of a migraine
Hippocampus
In what % of migraines is there aura
20-30%
What happens in the resolution phase of migraine
Vomiting
Deep sleep
Medication
What happens in the recovery phase of migraine
Tired
Diuresis
Limited food tolerance
What is aura
A transient and local suppression of spontaneous electrical activity in the cortex which moves slowly across the brain
What is the first stage of a headache
Dilated meningeal artery
What happens as a result of dilation of the mesangial artery
Inflammatory release of peptides
CGRP
What CGRP stand for
Calcitonin gene related peptide
What is the function of CGRP
Potent vasodilator
How do CGRP levels change during migraine attack
They rise spontaneously
What is the effect of neuropeptide release after dilation
Activates nerve pathways which send pain pathways to trigeminal pathway
What does the peripheral sensitisation mediate?
Throbbing pain
Where does the trigeminal nerve transmit the pain to
Spinal trigeminal nucleus in the brainstem
What is meant by allodynia
Over-sensitivity to a stimulus
What does central sensitisation mediate
Allodynia
When do these signals become a headache
Pain impulses move to thalamus for decoding
Where does preventative medicine for migraine work
Centrally
How do acute medications work
Via vasoconstriction
Do acute medications cross the BBB
Nah
Are triptans used preventitively or as treatment
Acute treatment
Name 6 triptans
Sumatriptan (some) Zolmitriptan (zoos) Naratriptan (never) Electriptan (elect) Almotriptan (altruistic) Frovatriptan (friends)
Name 4 CGRP monoclonal antibodies
Erenumab
Fremanezumab
Eptinezumab
Galcanezumab
