LG 1.5 Headache Scheme Introduction

Question 1

What is a primary Headache?

Answer 1

-Intrinsic to the brain without any underlying structural, infectious toxic/metabolic cause/psychiatric cause.

Question 2

What defines a migrane?

Answer 2

i. A Neurologic Disorder
ii. Various symptoms
iii. Episodes
iv. Usually headaches
v. Inherited

Question 3

What are the 3 types of migraines?

Answer 3

i. *Common no aura/headache;
ii. *Classic with aura and headache
iii. *Aura only/ no headache

Question 4

What are common symptoms of migraines?

Answer 4

1. Usually one-sided. Throbbing. Incapacitating
2. Nausea Vomiting
3. Sensitive to light and sound
4. Worse with movement or straining.

Question 5

What is the normal duration of a migraine?

Answer 5

Duration of 4-72 hours.

Question 6

How long does the aura normally last?

Answer 6

Aura lasts 5 to 60 minutes

Question 7

What are the four stages of migraines?

Answer 7

1) Prodrome: a day or so before the following migraine stages; Fatigue, Difficulty Concentrating; Irritability, Discomfort
2) Aura: generally right before the headache; usually resolves right before the headache starts
3) Headache: often one sided, throbbing
4) Post (postdrome)-after headache resolves there may be vague lethergy, confusion, difficulty with recognition, sluggishness

Question 8

What are some examples of migraine triggers?

Answer 8

i. Stress
ii. Hormones (women)
iii. Skipped meals
iv. Weather
v. Sleep changes
vi. Perfume

Question 9

What is the brainstem involvement with migraines?

Answer 9

It is the origin of the migraine; when activated can send pain centers directly to the brain and can initiate CSD.

Question 10

What is the Third cortical pathway involvement in migraines?

Answer 10

Some migraine sufferers have Abnormal Sensory Processing of pain signals; (that is, some people have a lower pain/migraine perception threshold; genetically based)

Question 11

What is the current migraine mechanism?

Answer 11

1) CNS Event trigger
2) Cortical Spreading Depression
3) Surface cortex
4) aura (neurons)
5) Depolarization (scintillations)
6) Depression (scotoma) Interior cortex
7) No aura (white matter) CSP (at 2-3mm./min.)

Question 12

What is involved with meningeal irritation?

Answer 12

Meningeal irritation (pain) to Trigeminal nerve (Cr.N V) to brainstem to pain sensitive areas of the brain via the thalamus

Question 13

What is a secondary headache?

Answer 13

Headache attributed to head and/or neck trauma,; cranial or cervical vascular disorder: non-vascular intracranial disorder; substance or its withdrawal; infection, disorder of homeostasis; psychiatric disorder; Headache or facial pain attributed to disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cranial structures

Question 14

What is a thunderclap headache?

Answer 14

so called because of its rapid onset and severity of pain. (like being hit with a bolt of lightening). Defining features include maximal pain intensity reached in seconds to a minute. (migraine generally reaches its peak over tens of minutes to hours).

Question 15

Why must you treat a thunderclap headache as an emergency?

Answer 15

-Must rule out a sudden intracranial bleed from ruptured intracranial aneurysm.

Question 16

What is a valsalva maneuver?

Answer 16

Forceably exhale while keeping mouth and nose closed

Question 17

What are the effects of a valsalva maneuver?

Answer 17

Increases intracranial pressure, intrathecal, intra abdominal pressure, increases cerebral blood flow resistance.