Migraines Flashcards
Primary vs Secondary Migraine
Primary migraines are due to a physiologic disruption – can be migraines, tension headaches, or cluster headaches.
Secondary migraines are due to neoplasms, infections, or aneurysms.
How to diagnose migraine without aura?
At least 5 attacks, which last from 4-72 hours.
Must have at least two of the following: unilateral location, pulsating quality, moderate to severe pain, aggravation by or avoidance of physical activity.
Must cause nausea/vomiting, or photophobia/phonophobia.
Not attributed to another disorder.
Migraine with aura
Must have at least 2 attacks.
Aura consists of one of the following without motor weakness: fully reversible visual symptoms, fully reversible sensory symptoms including positive/negative features, fully reversible dysphagic speech disturbance.
Must have at least two of the following:
Homonymous visual symptoms or unilateral sensory symptoms, at least one aura symptom gradually over 5 minutes.
Headache fulfills criteria for migraine without aura.
Not attributed to another disease.
What was the wrong theory about migraine?
That it was attributed to vascular phenomenon.
Current theory about migraine?
Caused by cortical spreading depression that moves about 3mm/minute.
How does CSD cause pain?
Neuronal activation leads to pain in meninges monitored by V1, then vasodilitation occurs via the superior salivatory nucleus. This is known as spreading oligemia.
How are glia involved in migraines?
Astrocyte calcium waves could cause the symptoms of migraine.
Tension-type
Headache that is bilateral and pressing, not aggravated by activity. Little or no nausea, photophobia, or phonophobia.
Neck pain during migraine. Cause?
Frequent – in 75% of subjects. Most describe as a tightness. Trigeminal nucleus caudalis extends to dorsal horn for C2-4, so that causes referred pain.
Autonomic activation during migraine?
Yes, trigeminal nucleus caudalis near superior salivatory nucleus, which causes activation of face parasympathetics leading to rhinorrhea and lacrimation.
Does chronic sinusitis cause headache?
No – only acute sinusitis.
Migraine with aura risk of stroke?
Increases risk – up to obesity, extreme hypertension risk.
Ocular causes of headache caused by?
Changes in the external appearance of the eye.
Red flags for headache
A new or different headache in children younger than 5 or adults over 50. Abrupt onset, history of HIV, cancer, pregnancy. Headache onset with seizure or sex. Headache onset with sex or valsalva.
Comfort signs for headache
Established history of stable headache pattern, family history or personal history of similar headaches, normal physical exam. Headache consistently triggered by hormonal cycle, specific foods, specific sensory input, weather changes.
Brain tumor headache
Similar to tension, but also with nausea, vomiting, change in prior headache pattern. Headache while sleeping.
Brain abscess headache
Similar to brain tumor headache, impaired sensorium, can occur with seizures.
Headaches from idiopathic intracranial hypertension
Brain tumor headache. Visual complaints like diplopia. Pulsatile tinnitus, N/V, radiculopathy.
Who gets idiopathic intracranial hypertension?
Obese females, vitamin A toxicity, Lupus.
Are all headaches that wake people up brain tumors?
No can be hypnic headache syndrome.
Stroke Headache
Numbness that spreads down and resolves up. Then throbbing headache. Most frequent in posterior circulation, can be abrupt or gradual. Severity not related to size of infarct.
Exploding headache
Subarachnoid hemorrhage. berry aneurysm. Sudden onset of severe headache, causes seizures and diplopia. Diagnose with non-contrast CT.
Thunderclap headache
Caused by both aneurysmal and nonaneurysmal SAH
Cluster headaches
Intense unilateral pain. Can cause ptosis, miosis. Happens more frequently in males. Can be both episodic and chronic.
Giant cell arteritis
Can cause headache. Often generalized, throbbing, temporal, tongue and jaw claudication.
Cardiac cephalgia
Referred pain of angina to head.
Horner’s Syndrome with throbbing unilateral headache
Carotid artery dissection
Low-pressure headache
30% of lumbar punctures, common in thin females, generally positional. Some have thunderclap onset.
How to treat low pressure headache
Direct repair, IV NA caffeine benzoate.
How to make sure rhinorrhea isn’t csf rhinorrhea?
Do a beta-2-transferrin test, or look for glucose.
Can postural orthostatic tachycardic syndrome cause headache?
yes.
Trigeminal neuralgia
You know this, usually affects V2 and V3
