Lecture 2 - Headache

Question 1

Migraine:
unilateral or bilateral?
clasically described as ____ pain with nausea, ____phobia, and ____phobia;
symptoms ____ with physical activity

Answer 1

unilateral;
pulsating/throbbing;
phono, photo;
worsen

Question 2

migraines:
last between ___ and ___ hours;
some patients may experience an ____ with neurologic symptoms such as ____ (visual) or ____ in patients with a familial channelopathy

Answer 2

4, 72;
aura;
scotomas;
hemiplegia (ie paralyzed goats)

Question 3

migraines:
CN _____;
gut motility is ____

Answer 3

hyperexcitability;

slowed

Question 4

migraine:

due to irritation of CN ___, ____, or _____

Answer 4

5 (Trigeminal), meninges, blood vessel

Question 5

migraine:

blood vessels release _____, _____, and vasoactive peptides –> vaso____ and protein extravasation –> neurogenic ______

Answer 5

substance P, calcitonin-gene releated peptide (CGRP), vasodilation;
inflammation

Question 6

migraine:
____ are released and facilitate production of prostaglandins. these sensitize meningeal ___ receptors –> decreased threshold

what Cranial nerve nucleus is important?

Answer 6

kinins;
pain;

trigeminal nucleus caudalis (TNC)

Question 7

migraine central sensitization:
____ neurons are activated early, this is the ___ pain phase;
____ neurons are activated later. this is the ____ pain phase

Answer 7

peripheral, mild;

central, migraine (ie v bad)

Question 8

acute treatment:
triptans, which are selective ____ agonists;
also _____

Answer 8

5HT1b and 5HT1d;

dihydroergotamine

Question 9

migraine prophylaxis:
2 anti-epileptics?
beta-blocker =
TCA =

Answer 9

valproate, topiramate;
propanolol;
amitryptiline

Question 10

childhood precursors to migraine:
cyclic ____;
____ pain;
benign paroxysmal vertigo

Answer 10

vomiting;

abdominal

Question 11

tension headaches:
unilateral or bilateral?
constant or pulsatile?
must last more than \_\_\_\_;
precipitated by physical activity or aura?
\_\_\_ tenderness

Answer 11

bilateral;
constant steady pain;
30 minutes;
nope;
pericranial

Question 12

cluster headache:
unilateral or bilateral?
constant or episodic?
how long do they last?
often precipitated by \_\_\_\_

Answer 12

unilateral;
episodic/repetitive;
15 min - 3 hours ie short;
alcohol use

also called “Trigeminal autonomic cephalgia”p

Question 13

cluster headache:
pain is ____;
localized in ____ or temporal regions;
autonomic symptoms such as ____, ____, conjunctival injection, ____ syndrome

Answer 13

excruciating;
peri-orbital;
rhinorrhea, lacrimation;
horner

Question 14

cluster headaches: treat with _____ and _____

Answer 14

sumatriptan + 100% O2

Question 15

post concussive headaches:
follows ____ trauma.
symptoms include headache with ____, ____ vision, insomnia, dizziness, trouble concentrating etc;

Answer 15

minor (ie car accident);

vertigo, blurred

Question 16

temporal arteritis:
classically affects who?
unilateral or bilateral headache?
jaw \_\_\_\_;
treat with \_\_\_\_

Answer 16

elderly females;
unilateral (follows temporal);
claudication;
high dose corticosteroids

Question 17

another name for idiopathic intracranial hypertension?

classically seen in who?

Answer 17

pseudotumor cerebri;
obese woman (or pregnant)

Question 18

pseudotumor cerebri:
drugs that can cause it include _____ (antibiotic), _____, _____ excess;

treat with weight loss, ____ ( a diuretic), serial _____

Answer 18

tetracycline, danazol, Vitamin A;
acetazolamide (or furosemide), LPs

also steroids, optic nerve fenestration

Question 19

post lumbar puncture headaches:

pain when _____ that resolves when ____;

Answer 19

standing;

lying flat

Question 20

medication overuse headache:
headaches are worse in the \_\_\_\_;
headaches resolve after what?
thought to involve \_\_\_\_ receptors;
classic cause

Answer 20

morning;
termination of subtance (Greater than 2 months);
serotonin;
caffeine (can confirm)