Migraines & Headache Flashcards
Primary Headaches (aka cephalgia)
- Muscular (tension)
- Vascular (migraines)
- Cluster (neurological)
Pathophysiology
- Headaches are the result of the reaction of nociceptors (pain-sensitive nerve endings) to triggers, sending msgs to the thalamus via the trigeminal nerve (CN V)
____ headache
Is a sx w/an organic cause such as a brain tumor or aneurysm, infection, medication-induced disorders, or idiopathic causes, & typ present w/a sudden onset of severe pain
Secondary
Secondary Headaches
- Sinuses
- Ear
- Nose
- Mouth
- Cervicogenic (joints, muscles, vertebrae)
- Referred pain from trigger points in neck, shoulders, & upper back
Primary Headache
- Has no known organic cause & incl migraine, tension HA, & cluster HA
Tension Headaches
- Muscular are usually TENSION headaches & are bilat usually to the occipital area; often feel pressure in the face, head, & neck often w/sensitivity to light
Episodic tension headaches
- Typ occur 10-15 days per month, lasting 30 min to several days
Chronic tension headaches
- Occur more than 15 days per month over a 3-month period & are generally more severe than episodic headaches
Cluster headaches
____
The clinical presentation typ incl severe, unrelenting, unilateral pain in & around the eye
Often causes excessive tearing/lacrimation
Neurovascular
Migraine headaches
- Premonitory/headache/postdromal phases
Migraines are vascular & are usually unilateral; w/sensitivity to light, sound, & smell; often accompanied w/ n/v
! Status migrainosus & hemicrania continua
Are syndromes where the headaches keep happening or don’t relent
Pts may need to be admitted for IV fluids & meds like dihydroergotamine mesylate (Migranal) & anti-emetics
Migraine Phases
- Prodromal (premonitory sx’s)
- Aura (in migraines w/auras)
- Headache
- Postdromal
- Migraines are usually one-sided, or unilateral pain
?
Is characterized by cortical spreading depression - a wave of depressed nerve activity that sweeps across the outer layer of the brain
Aura
Premonitory sx’s are believed to involve the neurotransmitters ___ and ___
dopamine; serotonin
? phase
Can be 24 hrs before the HA starts
Clinical sx’s are mood changes, fluid retention, inc u/o, excessive uncontrolled yawning, & food cravings
Premonitory
Assessment
- Headache diary
- Complete neurological assessment
- CBC, blood cultures, C-reactive protein, ESR, CSF testing, CT, MRI
Preventive Meds
- Anti-epileptics (lamotrigine [Lamictal], gabapentin [Neurontin])
- Anti-hypertensives
- Beta blockers (propranolol [Inderal])
- Calcium channel blockers (amlodipine [Norvasc])
> Thought to prevent the vasoconstriction or vasodilation in cerebral blood vessels
- Antidepressants; SSRIs/SNRIs; TCAs
Abortive Meds
- Ergot alkaloids (dihydroergotamine [Migranal] (help during early phases)
- Serotonin; sumatriptan [Imitrex]
! Triptans
Contraindicated for those w/actual or suspected heart ischemia or dz, cerebrovascular ischemia, HTN, PVD, or Prinzmetal’s angina r/t the potential for coronary vasospasm
Symptomatic Relief
- NSAIDs; combining acetaminophen w/caffeine
- Anti-emetics: prochlorperazine
> IV admin for status migrainosus
- Lifestyle modifications, CAM therapies, supplements, diet, sleep, exercise, hydration
- Avoid tyramine-containing foods; e.g., pickled foods; caffeine, beer, wine, preservatives, artificial sweeteners
