Headaches and migraines

Question 1

What is the difference between primary and secondary headaches

Answer 1

Primary= diagnosis made in the absence of physical signs
Secondary= diagnosis is made in the presence of physical signs

Question 2

3 main types of headaches

Answer 2

Tension headache
Migraine
Cluster headache

Question 3

What % of all headaches are tension headaches

Answer 3

80

Question 4

What % of headaches are migraines

Answer 4

15

Question 5

What % of headaches are cluster headaches

Answer 5

0.2-0.3%

Question 6

Which headache affects men more than women

Answer 6

Cluster

Question 7

When is a headache described as normal

Answer 7

When symptoms disappear once stimulus ire removed

Question 8

Symptoms of a cluster headache

Answer 8

Pain comes in clusters lasting 6-8 weeks
Severe pain behind eyes
Unilateral rhinorrhoea

Question 9

3 treatment options for cluster headaches

Answer 9

High flow oxygen for vasoconstriction
Triptans used to vasoconstrict
Verapamil

Question 10

How many attacks must a person have for it to count as migraine? How long must they last for?

Answer 10

5 in a lifetime

4-72 hours

Question 11

2 of which 4 characteristics must be seen to be categorised as an migraine

Answer 11

Unilateral pain
Pulsating
Moderate- severe pain
Aggravated by walking

Question 12

1 of 2 symptoms must be seen to be categorised as a migraine

Answer 12

NIV

Photophobia and phonophobia

Question 13

What is meant by the threshold of a headache

Answer 13

What stimulia can a person withstand before getting a migrain

Question 14

What molecule is released in the early stages of a migraine

Answer 14

5-HT

Question 15

What is the impact of releasing 5-HT in early stages

Answer 15

Constriction of dilated blood vessels

Dilations of constricted blood vessels

Question 16

What are triptans

Answer 16

5-HT1D/B agonist

Question 17

Name a prophylactic drug used to treat migraine

Answer 17

Methysergide

5-HT2b antagonist

Question 18

What are the 5 stages of a migraine

Answer 18

1) Premonitory phase
2) Aura
3) Headaches
4) Resolution
5) Recovery

Question 19

What happens in the premonitory phase of a migraine?

Answer 19

Cravings
Yawning
Fluid retention
Neck pain

Question 20

Which part of the brain is affected in the premonitory phase of a migraine

Answer 20

Hippocampus

Question 21

In what % of migraines is there aura

Answer 21

20-30%

Question 22

What happens in the resolution phase of migraine

Answer 22

Vomiting
Deep sleep
Medication

Question 23

What happens in the recovery phase of migraine

Answer 23

Tired
Diuresis
Limited food tolerance

Question 24

What is aura

Answer 24

A transient and local suppression of spontaneous electrical activity in the cortex which moves slowly across the brain

Question 25

What is the first stage of a headache

Answer 25

Dilated meningeal artery

Question 26

What happens as a result of dilation of the mesangial artery

Answer 26

Inflammatory release of peptides | CGRP

Question 27

What CGRP stand for

Answer 27

Calcitonin gene related peptide

Question 28

What is the function of CGRP

Answer 28

Potent vasodilator

Question 29

How do CGRP levels change during migraine attack

Answer 29

They rise spontaneously

Question 30

What is the effect of neuropeptide release after dilation

Answer 30

Activates nerve pathways which send pain pathways to trigeminal pathway

Question 31

What does the peripheral sensitisation mediate?

Answer 31

Throbbing pain

Question 32

Where does the trigeminal nerve transmit the pain to

Answer 32

Spinal trigeminal nucleus in the brainstem

Question 33

What is meant by allodynia

Answer 33

Over-sensitivity to a stimulus

Question 34

What does central sensitisation mediate

Answer 34

Allodynia

Question 35

When do these signals become a headache

Answer 35

Pain impulses move to thalamus for decoding

Question 36

Where does preventative medicine for migraine work

Answer 36

Centrally

Question 37

How do acute medications work

Answer 37

Via vasoconstriction

Question 38

Do acute medications cross the BBB

Answer 38

Nah

Question 39

Are triptans used preventitively or as treatment

Answer 39

Acute treatment

Question 40

Name 6 triptans

Answer 40

``` Sumatriptan (some) Zolmitriptan (zoos) Naratriptan (never) Electriptan (elect) Almotriptan (altruistic) Frovatriptan (friends) ```

Question 41

Name 4 CGRP monoclonal antibodies

Answer 41

Erenumab Fremanezumab Eptinezumab Galcanezumab