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BB2 > Migraine and Headache > Flashcards

Migraine and Headache Flashcards

1
Q

primary headache

A

headache with no clinical signs

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2
Q

secondary headache

A

headache with clinical signs

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3
Q

what signs may be present in a secondary headache

A

tumour
fits
temperature
rash
stiff neck

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4
Q

3 main types of primary headaches

A

migraine
cluster
tension

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5
Q

what causes a tension headache

A

brain response to factor adversely affecting function

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6
Q

how does a tension headache feel

A

bilateral band like tightness/pressure/dull ache
can radiate to neck and shoulders

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7
Q

are tension headaches aggravated by movement

A

no

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8
Q

are tension headaches relieved by painkillers

A

yes

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9
Q

how long do tension headaches last

A

30 mins-several days

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10
Q

why does medication overuse cause headaches

A

suppression of endogenous pain response cause headaches when painkillers stopped

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11
Q

what is the most painful headache type

A

cluster

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12
Q

what triggers a cluster headache

A

blood vessel dilation - eg due to alcohol

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13
Q

how long do cluster headaches last

A

usually less than 3 hrs
often in seasonal attacks of 6-8 weeks

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14
Q

cluster headache treatment

A

high dose oxygen via non rebreather mask
tryptans

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15
Q

cluster headache prophylaxis

A

verapamil

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16
Q

how long do migraines last

A

4-72 hrs

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17
Q

characteristics of migraines

A

unilateral
pulsating
moderate-severe
photophobia
phonophobia
nausea
vomiting

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18
Q

are migraines aggravated by physical activity

A

yes

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19
Q

phonophobia

A

fear of sound

20
Q

difference between episodic and chronic migraines

A

episodic - <15 days/month
chronic - >15 days/month for 3+ months

21
Q

what brain abnormality leads to migraines

A

hypervigilant brain unable to filter out unnecessary stimuli

22
Q

what can trigger a migraine

A

hormones
lack of food
dehydration
lack of sleep

23
Q

what are the 2 types of migraine

A

with aura
without aura

24
Q

does 5HT trigger or relieve migraines

A

relieve

25
Q

5 stages of a migraine

A

premonitory
aura
headache
resolution
recovery

26
Q

aura

A

visual/sensory/speech/language symtoms

27
Q

when and how long does aura occur

A

20mins-1 hr
usually resolves before headache

28
Q

how does visual aura appear

A

zigzag lines spreading across field of vision

29
Q

what causes aura

A

cortical spreading depression

30
Q

cortical spreading depression

A

transient and local suppression of spontaneous activity in the cortex moving slowly across the brain

31
Q

activation of which system is implicated in migraine

A

trigeminovascular system

32
Q

does CGRP level increase or decrease during migraine attacks

A

increase

33
Q

how are CGRP levels effected by triptans

A

decreased

34
Q

2 parts of migraine pathophysiology

A

peripheral sensitisation - trigeminal ganglion sensitised
central sensitization - dorsal horn sensitised

35
Q

migraine pathophysiology

A

neuropeptides activate nerve pathways -> pain signals to trigeminal ganglion -> trigeminal nerve transmits pain to SpV in brainstem -> pain relayed to thalamus and onto cortex

36
Q

how can a migraine be stopped

A

cannot be stopped once started

37
Q

migraine treatment

A

5HT agonists
Gepants
CGRP monoclonal antibodies

38
Q

what type of drug are triptans

A

5HT agonist

39
Q

triptan examples

A

sumatriptan
zolmitriptan
naratriptan
almotriptan
frovatriptan

40
Q

triptan action

A

vasocontriction

41
Q

what are Gepants

A

small molecule CGRP receptor antagonists

42
Q

Gepant examples

A

rimegepant
ubrogepant

43
Q

are gepants taken acutely or preventatively

A

acutely
preventative in clinical trials

44
Q

are CGRP monoclonal antibodies used acutely or preventatively and how are they administered

A

preventatively
monthly SC injection

45
Q

how do CGRP monoclonal antibodies work

A

bind to CGRP or CGRP receptor to prevent vasodilation

46
Q

CGRP monoclonal antibody examples

A

erenumab
eptinezumab
fremanezumab
galcanezumab

BB2 (26 decks)

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