Lecture 88 - Headaches Flashcards
The release of neurogenic peptides that cause the pain associated with migraines is modulated by _______ (5-HT) receptors. These peptides cause neurogenic inflammation that transmits pain signals via the ______ nerve.
Serotonin (5-HT) receptors
Trigeminal nerve
Primary headaches are classified as ______, ______, or _______. If there are “red flags” when taking the patient’s history, which include ______ (sudden or progressive?) onset, a worsening pattern, focal neurological symptoms, etc., consider Secondary headaches which are classified as ______, _______, or _______.
Migraine, Tension, or Cluster
Intracranial, Paracranial, or Extracranial
_____-_______ _____ is used to detect SAH and can capture up to 95% of cases. When it doesn’t, try _____ puncture (keep in mind ________ in the LP helps distinguish between Traumatic and Subarachnoid).
Non-contrast CT
Lumbar Puncture
Xanthochromia
Giant Cell Arteritis (aka Temporal arteritis) is most common in ______ (young or old?) patients. They often present with Jaw ________ (which is moreso a tiredness than a pain). Diagnosis is most common and accurately done by Temporal artery _____. Treatment is ______.
Old
Claudication
Biopsy
Steroids
Cerebral Venous Thrombosis (CVT) causes headaches via increased ________ pressure. Patients expreience a diffuse, ________ (sudden or progressive?) and constant pain. _______ and sizures are common in these patients as well.
Increased ICP
Progressive
Papilledema
Pseudotumor Cerebri is a common cause of headaches in young, obese women. It is caused by increased ICP, so look for symptoms related to that.
How do you diagnose this?
Lumbar puncture with CSF pressure > 20cm H2O in Nonobese or CSF > 25cm H2O in Obese
Of the primary Headaches, _______ tend to last on the order of 4 - 72 hours, ______ tend to last anywhere from 30mins - several days, and ______ tend to last 30-120mins.
______ tend to be Unilateral, ______ tend to be Bilateral, and _______ tend to be Unilateral AND Retro-orbital.
______ tend to be Throbbing pain, ______ tend to be Pressure pain, and _______ tend to be Stabbing pain.
Migraine –> 4-72hrs
Tension –> 30mins-several days
Cluster –> 30mins-120mins
Migraine –> Unilateral
Tension –> Bilateral
Cluster –> Unilateral AND Retro-orbital
Migraine –> Throbbing
Tension –> pressure
Cluster –> Stabbing
For Migraine classification, patients must present with at least 1 of the following:
_____ and/or ______ (this can be one or the other)
______ and ______ (this must be both)
Nauea and/or Vomiting
Photophobia AND Phonophobia
Triptans are used as Acute Abortive migraine therapy and act in 3 ways:
- _______
- Inhibition of _____ neurogenic inflammation
- Central inhibition of pain by inhibiting ______ neurons.
- Vasoconstriction of meningeal, dural, and pial vessels
- Inhibition of Dural neurogenic inflammation
- Central Inhibition of pain by Inhibiting Trigeminal neurons
______ is a neuropetide known to cause vasodilation and inflammation leading to migraines. Blocking it or its receptors have become a target for migraine treatment.
CGRP
In Tension headaches, patients can present with _______ OR _______, but NOT both.
Photophobia
Phonophobia
_____ headaches are the most common Trigeminal Autonomic Cephalgia (TAC) and present with severe _______ (unilateral or bilateral?) pain with associated Lacrimation, Sweating, Ptosis, Conjunctival injetion, or eyelid edema. They are sometimes precipitated by Alcohol, Histamine, or Nitorglycerine.
Acute abortive therapy for these headaches is limited, but Triptans can be used. Most patients receive supplemental _______.
______ ______ blockers (i.e. Verapamil) are used as preventative therapy.
Cluster
Unilateral (and often retro-orbital)
Supplemental Oxygen
Ca++ Channel blockers (Verapamil)
