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PR3153 CA1 > IC5: Headache > Flashcards

IC5: Headache Flashcards

1
Q

What is SNNOOP10 used for?

A

red flags for secondary HA

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2
Q

What does SNNOO stand for?

A
  1. systemic sx (fever)
  2. neoplasm hx
  3. neurologic deficit
  4. onset of HA sudden
  5. older age (over 50)
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3
Q

What does P10 stand for

A
  1. pattern of change or recent onset
  2. positional HA
  3. precipitated by sneezing or exercise
  4. papilledema
  5. progressive HA with atypical presentation
  6. pregnancy
  7. painful eye
  8. post-traumatic onset of HA
  9. pathology of immune system
  10. painkiller overuse or new drug at HA onset
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4
Q

Differentiate TTH and migraine in terms of pain location

A

TTH - bilateral
Migraine - unilateral usually

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5
Q

Differentiate TTH and migraine in terms of pain quality

A

TTH - tightening
Migraine - pulsating, throbbing

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6
Q

Differentiate TTH and migraine in terms of pain intensity

A

TTH - mild to moderate
Migraine - moderate to severe

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7
Q

Differentiate TTH and migraine in terms of effect of/on routine activities

A

TTH - not aggravated by routine activities
Migraine - aggravated by or causes the avoidance of routine activities

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8
Q

Differentiate TTH and migraine in terms of duration

A

TTH - 30mins to 7 days
Migraine - 3 to 72h

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9
Q

What is the key to NPM in TTH management?

A

Patient education to identify triggers, recommend a headache diary (take note of events and quality of HA)

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10
Q

What are pharmacological management options for TTH? (3 + 3)

A

acute - paracetamol (w/wo caffeine), aspirin, NSAIDs (ibuprofen, naproxen)

prophylactic - amitriptyline, mirtazapine, venlafaxine

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11
Q

What are non-pharmacological management options for TTH?

A

CBT, biofeedback, lifestyle modification (including sleep hygiene)

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12
Q

What are the 5 migraine phases?

A

Prodrome
Aura
HA (ictal)
Postdrome
Interictal

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13
Q

Which symptoms are experienced in most of the phases? (5)

A

Photophobia, phonophobia, fatigue, neck discomfort, nausea

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14
Q

What actions outline the prodrome phase? (2)

A

Hypothalamus activation
Neuropeptides involved in homeostatic functions

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15
Q

What action outlines the aura phase?

A

Cortical spreading depression (CSD) resulting in slow-spreading depolarisation within the grey matter that inhibits cortical activity

CSD may also activate the trigeminovascular system, driving aura symptoms

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16
Q

What action outlines the ictal phase?

A

neuropeptides (including CGRP) sensitise the trigeminovascular system and create a state of hypersensitivity

17
Q

What action outlines the postdrome phase?

A

Similar to prodrome:
hypothalamus activation and neuropeptide release

18
Q

What action outlines the interictal phase?

A

Some regions of the brain remain abnormally activated after headache cessation, including the olfactory regions, the midbrain, and the hypothalamus

19
Q

How is episodic migraine diagnosed

A

during a lifetime, ≥ 5 migraine attacks lasting 4-72 hours

20
Q

How is chronic migraine diagnosed

A

≥ 15 MHDs and ≥ 8 MMDs over > 3 months

21
Q

What is an MHD

A

monthly HA day

a day with migraine-type or tension-type headache

22
Q

What is an MMD

A

monthly migraine day

at least 2/4: unilateral, pulsating, mod/severe, avoid physical activity

if no aura, at least 1/2: photo/phonophobia, n/v

23
Q

Which two classes of medications are specifically implicated in medication overuse HA?

A

Opioids and barbituates

24
Q

What is the first line and second line for acute migraine treatment?

A

First line: analgesics like NSAIDs or paracetamol/aspirin if NSAIDs are contraindicated

Second line: triptans

25
Q

What are the triptans’ MOA and what do they inhibit? (3)

A

Triptans are agoists of 5-HT(1B) and 5-HT(1D) receptors, decreasing trigeminal neuron activity

they inhibit 3 things:
- cerebral blood vessels,
-vasoactive peptide release by trigeminal neurons
- nociception

26
Q

Which agents can be used for CGRP receptor blockade? (2)

A

erenumab, gepants

27
Q

Which agents can be used for CGRP blockage? (1)

A

monoclonal antibodies like eptinezumab

28
Q

Which agents stimulate 5-HT (1B/1D) receptors

A

triptans

29
Q

Which agents stimulate 5-HT (1F) receptors

A

ditans

30
Q

What can be used for adjunctive treatment?

A

Metoclopramide for nausea

31
Q

What are the contraindications to cafergot use? (4)

A

CVD, CHD, recent stroke, uncontrolled hypertension

(due to vasoactive effect)

32
Q

What does AHS recommend for when to start preventative treatment?

A

in terms of HA days / month, start if
≥ 6 days w no disability
≥ 4 days w some disability
≥ 3 days w severe disability

33
Q

What 2 classes of drugs can be given for preventative treatment of migraines? (2 + 2)

A

ASM (topiramate, valproate)
BB (propranolol, metoprolol)

PR3153 CA1 (5 decks)

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