Migraine Flashcards
Migraine Etiology and Epidemiology
-Common disabling primary disorder and the second leading cause of disability.
-Strong genetic Component affecting mostly women (Age: 30-39)
Classification of Migraines
-Migraine without aura (common migraine)
-Migraine with aura (classic migraine)
-less than 15 episodes per month
-Chronic Migraine
-More than 15 episodes per month
Possible migraine factors
Sleep disturbances and aspartame
-stress is the highest trigger
Migraine Pathophysiology
-The Vascular Theory of Migraine is no longer considered but suggested that the headaches were caused by dilation of blood vessels and the aura from vasoconstriction.
-Cortical Spreading Depression is the one we accept at the moment.
Cortical Spreading Depression (CSD)
- Fast wave of neuronal and glial depolarization across the brain
- Frontal excitation in cortex.
- Massive increase in intracellular sodium and calcium and extracellular glutamate and potassium
- Causes inflammation in meninges and/or directly stimulates the trigeminal nerve.
Migraine Aura
-Caused by the Cortical Spreading Depression (CSC)
-Last less than an hour
Positive Symptoms:
-stimulates vision, hearing, feeling or movement.
Negative Symptoms:
-loss of vision, hearing, feeling or movement.
What are the components of the Trigeminocervical Complex (TCC)
-Trigeminal Nerve (Cranial Nerve V)
- stimulation results in release of vasoactive neuropeptides such as substance P, calcitonin gene-related peptide (CGRP), and neurokinin A which promotes inflammation.
-Trigeminal Ganglion
Trigeminal nucleus caudalis
Neurovascular pain in Trigeminal area
Trigeminovascular system
- calcitonin gene related peptide (CGRP) released in brainstem causing inflammation, vasodilation, and pain
Migraine Clinical Features (POUND)
-Pulsating Pain (throbbing)
-One-day duration (4-72 hours)
-Unilateral (one-sided)
-Nausea and vomiting
-Disabling intensity
Four phases of a typical migraine attack
-Prodrome (days to hours before the aura)
-the aura
-the headache
-the postdrome
Migraine Diagnosis without aura
-At least 5 attacks lasting 4-72 hours
-headache has at least two:
-Unilateral position
-Pulsating quality
-Modarate or severe pain intensity
-Aggravation by or causing
avoidance of routine physical
activity
-During headache at least one:
-Nausea and/or vomiting
-Photophobia and Phonophobia
Diagnosis of Migraine with Aura
-At least two migraine attacks fulfilling criteria B and C
-One or more of the following symptoms:
-Visual
-Sensor
-Speech and/or language
-Motor
-Brainstem
-Retinal
-At least Three of the following:
-At least one aura symptoms spreads
gradually over 5 minutes
-Two or more aura symptoms occur
In succession
-At least one positive aura symptoms
-At least one asura symptom
unilateral
Migraine in Children
-Attacks from 2-72 hours
-At least three of the following:
-Aura
-Throbbing headache
-Unilateral location
-Nausea & vomiting
-Abdominal pain
-Family History
-Relief during sleep
Cluster Headache
-Caused by Trigeminal Automatic Cephalgia (TACs)
-Unilateral headache (The pain would be in the same side of the head)
Cluster Headache Epidemiology
-Prevalence less than 1%
-Most common in men
-Risk factors: Family history, tobacco use, and head trauma
Cluster Headaches Pathophysiology
-Hypothalamic activation-> Alterations in circadian rhythm; changes in cortisol, testosterone, prolactin, melatonin, etc.
-Activation of trigeminovascular neurons-> release of vasoactive neuropeptides; neurogenic inflammation.
-Genetic Predisposition
Cluster Headache Clinical Features (ROUND)
-Restlesness or agitation
-Orbital or supraorbital location
-Unilateral and very severe pain
-Nasal or ocular symptoms
-Duration shorter
Cluster headaches Triggers
-Watching television
-Alcohol
-Hot Weather
-Stress
-Use of nitroglycerin
-Sexual Activity
-Glare
Cluster Headache Diagnosis
-At least five attacks
-Temporal pain lasting 15-180 minutes
-At least one of the following:
-Conjunctival injection/Lacrimation
-Nadal congestion/Rhinorrhea
-Eyelid Oedema
-Forehaed and facial sweating
-Miosis/ptosis
-A sense of restlessness or agitation
Tension Type Headache (TTH) Epidemiology
-Lifetime prevalence of 30% to 78% in general population
-Slightly higher prevalence in female
TTH Pathophysiology
-Pathogenesis: Peripheral activation or sensitization of myofascial nociceptors.
-Central Factors: Heightened sensitivity of pain pathways in CNS
-Peripheral Factors: Muscular factors important in episodic TTH
-Genetic Component
Clinical Features (PIVOT)
-Physical Activity does not aggravate symptoms
-Intensity is mild to moderate
-Variable duration (30min to 7days)
-Occipitofrontal and bilateral
-Tightening or pressing pain (not pulsatile)
Diagnosis of Infrequent TTH
-At least 10 episodes of headaches occurring on less than a day/month on average (less than 12 days/year)
-Lasting 30 minutes to 7 days
Diagnosis of Frequent TTH
-At least 10 episodes of headaches occurring 1-14 days/month on average for more than 3 months.
-Lasting 30 minutes to 7 days
