Headaches II Flashcards
What are the features of migraines?
Tendency to repeated attacks Triggers easily hung-over visual vertigo motion sickness
What are the three forms of migraine attacks?
Pain
Pain and focal symptoms
Focal symptoms
What are the phases of migraines?
Prodrome Aura Headache Resolution Recovery
What is prodrome?
Changes in mood, urination, fluid retention, food craving, yawning
What is aura?
Visual, sensory (numbness/paraesthesia), weakness, speech arrest
What is headache?
Head and body pain, nausea, photophobia
What is resolution?
rest and sleep
What is recovery?
mood disturbed, food intolerance, feeling hungover
48 hours or so
What are negative aura symptoms?
Blackness
Loss of vision
What are positive aura symptoms?
Flashes
Zigzags
Starburst
Expanding Cs
What are treatments for an acute migraine attack?
Analgesia
Soluble preparations to aid absorption
Triptans-tablets (Sumitriptan), melts, nasal sprays, s/c injections (vasoconstrictors)
Synergise with NSAIDS
Hit the headache hard and fast
Opiates
A short nap
TMS
How can TMS treat migraine?
interrupts complex networks that trigger and perpetuate migraine, which is caused by spreading electrical depression across the cerebral cortex.
Why do have to be careful with opiates?
caution! Analgesic abuse potential.
What are lifestyle issues that come with migraines?
Migraineurs have sensitive heads even in between attacks.
Over-react to any sort of stimulation.
Can’t ignore the world around them, it overstimulates their brains.
What are potential migraine triggers?
dietary, environmental, hormonal, weather, dehydration, stress
Drink 2 litres water/day
Avoid caffeinated drinks
Don’t skip meals. Fresh food. Avoid ready meals & take-aways
Don’t oversleep or have late nights.
Electronics downstairs.
Analgesic abuse
What prophylactic methods can prevent migraines?
Over-the-counter preparations
Tricyclic antidepressants (TCAs)
Beta-blockers
Serotonin antagonists
Calcium channel blockers
Anticonvulsants
Greater occipital nerve blocks
Botox: crown of thorns
Suppress ovulation
What over the counter preparation can be used?
feverfew, coenzyme Q10, riboflavin, magnesium, EPO, nicotinamide
What TCAs can be used?
amitriptyline 7pm
What beta blockers can be used?
Propanlol
Atenolol
What serotonin antagonists can be used?
pizotifen, methysergide
What calcium channel blockers can be used?
flunarazine, verapamil
What anticonvulsants can be used?
: valproate, topiramate, gabapentin
What is erenumab?
Injectable drug erenumab (Aimovig)
Monoclonal antibody
disables calcitonin gene-related peptide or its receptor (CGRP mAbs)
What does erenumab do?
cut number of days people had migraines from an average of 8 a month to between 4 and 5 a month
What is a tension type headache?
Tight muscles around head and neck bilaterally, as though head is in a vice.
How do you treat tension type headache?
NSAID’s preferred:
Ibuprofen Naproxen, Diclofenac
Paracetamol
Tricyclic antidepressants:-
Amitriptyline 50-75mg daily
30-60% derive some symptomatic relief
SSRI’s probably less effective
What is a cluster headache?
Severe unilateral pain lasting 15-180 minutes untreated.
Classified as a trigeminal autonomic cephalgia. (phantom of the opera distribution)
At least one of the following, ipsilaterally:
Conjunctival redness and/or lacrimation
Nasal congestion and/or rhinorrhoea
Eyelid oedema
What are other symptoms of cluster headaches?
Forehead and facial sweating
Miosis and/or ptosis
A sense of restlessness or agitation
Frequency between one on alternate days to 8 per day.
Not associated with a brain lesion on MRI
How do treat cluster headaches?
Inhaled oxygen. Oxygen inhibits neuronal activation in the trigeminocervical complex
S/C or Nasal Sumatriptan so it acts faster
What drug can you give to prevent prophylactically cluster headaches?
Verapamil (CCB)
What is the difference in distribution between migraines and cluster headaches?
M: 33% men, 67% women
CH:90% men, 10% women
What is the difference in duration between migraines and cluster headaches?
M: 3-12 hours
CH: 45min – 3 hours
What is the difference in frequency between migraines and cluster headaches?
M: 1-8 attacks monthly
CH: 1-3 attacks daily (often at night)
What is the difference in remission between migraines and cluster headaches?
M: Long remissions unusual
CH: Long remissions common
What is the difference in nausea between migraines and cluster headaches?
M: Nausea & vomiting frequent
CH: Nausea rare
What is the difference in pain between migraines and cluster headaches?
M: Pulsating hemicranial pain
CH: Steady, exceptionally severe, well localised pain, unilateral in each cluster
What is the difference in symptoms between migraines and cluster headaches?
M: Visual or sensory auras seen
CH: Eye waters, nose blocked, ptosis etc
What would SOCRATES be for a tension headache?
Generalised site Dull, band around head pain Radiates to neck/shoulder Lasts 3-4 hours Exacerbating factors - stress, no sleep, anaglesia helps
What are the investigations for a tension headache?
Clinical diagnosis
What would SOCRATES be for a migraine?
S: Unilateral O: Paroxysmal (episodic) C: Pulsating/Throbbing A: N&V, Photophopbia, Aura T: 4-72 hours E: Activity, stress, hormone, menstruation, OCP, foods e.g. tyramine in cheese/wine S: Moderate to Severe
What are the causes of migraines?
CHees OCP Caffeiene alcohOL Travel Exercise CHOCOLATE
What are the features of Migraines?
POUND Pulsatile One day diraation Unilateral Nausea Disabling intensity
What would SOCRATES be for a cluster headache?
S: Unilateral, behind the eye
O: Acute onset, same time each day
C: often burning/piercing pain
A: swollen eyelid, forehead swelling, nasal congestion, partial horner’s syndrome
What are some features of cluster headaches?
Males primarily
Associated with
