LG2.7/2.8 Headache Disorders Flashcards
What is a primary headache?
- Those in which there’s an intrinsic dysfunction of the Nervous System (often Genetic; predisposed to headache attacks)
- No underlying structural, infectious, toxic/metabolic cause.
What is an example of primary headache?
Migraine, cluster headaches, tension headaches.
What is a secondary headache?
- Those where headaches are Secondary to organic or physiologic or psychiatric processes (intracranially or extracranially)
- An identifiable underlying cause
- Examples: tumor, hemorrhage, meningitis
What are common symptoms of migraine?
- Usually one-sided. Throbbing. Incapacitating
- Nausea Vomiting
- Sensitive to light and sound.
- Worse with movement or straining.
- Duration of 4-72 hours
What is the Cortical Spreading Depression?
- Visual, Zig zag flashes(+), Scotoma (-)
* Sensory, weakness, trouble speaking, reversible, lasts 5 to 60 minutes
How do you differentiating migraine from ocular symptoms?
-one eye only, not scintillating scotomas
How do you differentiate migraine from detached retina?
-one eye, doesn’t improve but progresses
Differentiate migraine from stroke?
- Affects both eyes.
- Aura Spreads Slowly.
- Has positive features (of Aura).
- Recurring episodes follow a pattern.
- Reversible
- Other suspected clues.
What are increased risks of stroke related to Migraines?
- Migraine with Aura > Migraine without aura > No migraine history.
- Migraine + smoking increases risk of stroke 9x
- Migraine + Oral contraceptives (BCP’s) increases stroke risk 7x
What are the three simple screening questions for migraine patients?
DISABILITY, NAUSEA, PHOTOPHOBIA
What are the four specific questions for migraine patients?
1) Do you have headaches that interfere with work, social or family functions?2) Has your headache pattern been stable over the past six months?
3) How frequently do you experience headaches?
4) How effective is your current headache treatment?
Do brain tumors normally cause pain?
Brain cannot perceive pain within the brain, brain tumors rarely have headache as a presenting symptom.
Where does the pain in the brain come from?
- Cortex and meninges directly cause pain via blood vessels and stimulates the Trigeminal nerve which passes pain to the area of the cerebral cortex for processing
- Brainstem is center of sensory pain information passing to the brain
- Brainstem passes signals to cerebral cortex for CSD as well as pain.
- Genetic: Migraine patients have a abnormal sensory pain processing from trigeminal nerve/brainstem through the Thalamus. Lower threshold to produce migraine headache.
What is the action of serotonin?
- Vasoconstrictor
- Regulates mood, pain, appetite and sleep
What is found in low levels in Migraine sufferers?
• Low serotonin levels found in Migraine suffers
How do Triptans work?
Triptans work in acute treatment of migraine by blocking inflammatory chemicals in the meninges
What antidepressant may help with migraines?
SSRI’s
What perivascular vasoactive neuropeptides causes inflammation and is tied to migraines?
Calcitonin gene-related peptide (CGRP)
What is a Menstrual migraine?
Related to estrogen flux at time of menses
What is a Basilar Migraine?
Starts at the base of the skull, symptoms include vertigo, slurred speech, unsteadiness suspect CSD posteriorly perhaps in brainstem/cerebellar areas
What is an abdominal Migraine?
Children, family history of migraine, periodic attacks.
What is a Status Migrainosis?
very rare; lasts long, requires hospitalization
What is a Chronic Migraine?
Note on Secondary Headache part of Scheme; an overlap with tension headaches, and medication overuse headaches
Is a migraine a brain disorder?
Migraines are a brain disorder
What is allodynia?
-Painful reaction to otherwise non painful stimuli
What is Central sensitization?
Central amplification of pain response and threshold.
What is Neuronal sensitization?
Process where neurons become increasingly responsive to pain stimuli
What is sensitization?
Results in decreased response threshold, increased response magnitude, and expansion of receptive fields