Migraine/Headache Lecture

Question 1

A neurotransmitter that activates pain fibers and contributes to vascoconstriction and inflammation

Answer 1

Serotonin

Question 2

Serotonin receptor agonists are used to….?

Answer 2

Abort migaine headaches (if taken early enough)

Question 3

_______ is contributed to by activation of a wave of electrical activity that spreads throughout the brain, depressing cortical activity and resulting in visual and other symptoms

Answer 3

Aura

Question 4

“Spreading depression of Lao” on PET scans can be seen during…

Answer 4

Aura

Question 5

Are migraines lateralized or generalized?

Answer 5

Can be both/either.

Question 6

Prolonged aura with neurologic deficits lasting 1 hour up to a week (RARE)

*possible to have permanent neuro deficits, consistent with localized stroke

Answer 6

Complex migraine

Question 7

Drug class (other than ASA or NSAIDs) that you can take once you start experiencing a migraine?

Answer 7

“Triptan” drugs

Question 8

What is a class that can be used prophylactically in migraines?

Answer 8

Beta blockers

Question 9

Indications for migraine prophylaxis?

Answer 9

*Limited ability to work or do daily activities 3 or more days a month

*Severe or prolonged HAs

*Hx of migraine associated with complication (complex migraine, stroke)

Question 10

Episodic and chronic forms; symmetric tightness/pressure; mild/mod pain (minutes-days)
do not worsen with physical exertion, no nausea or vomiting or other neuro sx.

MC type of HA
Benign

Answer 10

Tension HA

Question 11

Tx of tension HAs?

Answer 11

Acetaminophen
NSAIDs

Question 12

Aka: Migrainous neuralgia.

Much less common than migraine or tension HA’s.

Male 6x> female, 3rd-6th decade

Answer 12

Cluster HAs

Question 13

Recurrent episodes of intense unilateral orbital, supraorbital, or temporal head pain along with ipsilateral partial cervical sympathetic paralysis
(conjunctival injection, lacrimation, rhinorrhea, nasal congestion, eyelid edema, loss of facial sweating)

last 15” to 2 hrs and recur daily for days to weeks.

Answer 13

Cluster HAs

(triggers= ETOH, glare, stress, foods)

Question 14

Any headache occurring > 15 days/month (often for 3 mos or more).
Often develops over time in a patient with intermittent HA’s.

*often caused by medication overuse/rebound

Answer 14

Chronic daily headaches

Question 15

Tx for cluster HAs?

Answer 15

Oxygen

Question 16

Symptoms: usually dull bifrontal or occipital headaches that begin in the a.m., are worsened by exertion or postural changes and may be associated with N & V.

Clues: new onset HA’s in patients >45 y.o. Usually associated with other neurologic findings, focal or diffuse (generalized disturbance of cerebral function).

Answer 16

Intracranial mass lesions

Question 17

50% gliomas, remainder are meningiomas, astrocytomas, acoustic neuromas, others.

Signs: Neuro defects, papilledema, personality changes, intellectual decline, seizures and emotional lability.

Dx: CT or MRI

Answer 17

Intracranial mass lesions