Migraines & Headaches Flashcards
Define primary and secondary headaches [2]
Primary headaches
Diagnosis is made on the history in the absence of physical signs
Secondary headaches
Diagnosis is made on the history in the presence of physical signs
What are the three types of primary headache? [3]
- migraines
- tension-typeheadaches
- cluster headaches.
Primary headaches
Describe the symptoms of tension-type headaches [5]
- Band-like, bilateral
- Tightness/pressure/dull ache
- Radiate to neck and shoulders
- Mild to moderate
- Not aggravated by movement
- 30 min to several day
Primary headaches
Treatment of tension-type headaches [2]
- Take painkillers for symptoms
- Find root causes and treat
Which are the most painful types of headaches? [1]
Cluster headaches
State the characteristics of cluster headaches:
- How long do they last? [1]
- When do they occur? [1]
- Name an immediate trigger of cluster headaches [1]
- Typically last 15-180 mins
- Seasonal: often last 6-8 weeks
- Alcohol is an immediate trigger
Define cluster headaches
a neurological disorder characterized by recurrent severe headaches on one side of the head, typically around the eye(s).
Name acute [2] and prophylactic [1] treatment for cluster headaches
Acute:
* oxygen (15L/min 100% through non-rebreather mask – acts as vasoconstrictor);
* -triptans
Prophylactic
* : has to be quick. High dose of verapamil
Primary headaches:
Name the 3 questions need to ask for diagnosis of a migraine [need score of 2/3]
Light bothers you (a lot more than when you don’t have headache)
Your headaches limit your ability to work, study or do what you need to do?
You feel nauseated or sick
Primary headaches:
What is the difference of length of migraines between episodic and chronic migraines? [2]
Episodic
* <15 days/month
Chronic
* Headache occurring on ≥15 or more days/month for more than three months. At least 8 days/month have the features of migraine headache
State the characteristics of migraines [5]
visual disturbance, nausea, vomiting, and sensitivity to light or noise (photophobia and phonophobia).
Migraine pathophysiology
Migraine pathophysiology
State the genetic influences on the pathophysiology of migraines [2]
- Migraineurs inherit ‘hypervigilant’ brains
-
Heightened senses. Can’t filter out
smell
lights
sounds
touch
Chemical changes that occur in migraine cause the person to be removed away from stimuli. (quiet, dark and allow recover)
Migraine pathophysiology
Name 4 examples that can cross migraine threshold (& cause migraine)
- Lack of sleep
- Lack of food
- Dehydration
- Hormonal trigger
Whats the difference between prevelance in migraine without aura vs migraine with aura
Migraine without aura
* 70-80% attacks
* Often menstrual headhaches
Migraine with aura
* 20-30% attacks
* 1% without headache
* more likely to effect men
When does a migraine start? [1]
Often occur 24 hrs before headache symptoms occurs
What are the 5 stages of migraine? [5]
Premonitory
Aura
Heachache
Resolution
Recovery
Describe the NT that influences migraines [1]
What urinary metabolite would be high in migraine attacks? [1]
Seratonin released (90% from gut, 10% platelets, 1-2% brain)
Increase urinary metabolites 5HIAA in attacks
Where in the brain do migraines start [1]
Hypothalamus
Describe 5 symptoms of premonitory phase of migraine
Food craving
Yawning
Neck pain
Heightened perception
Fluid retention
Describe what is meant by an ‘aura’ migraine [5]
These disturbances can include flashes of light, blind spots, and other vision changes or tingling in your hand or face
- Gradual development
- Duration of each symptom typically 20-30 mins - ≤1 hour
- Complete reversibility
- Typically resolves BEFORE onset of headache
Describe the pathophysiology of aura of migraine
A transient and local suppression (depression)
…of spontaneous electrical activity in the visual cortex (cortical)
…which moves slowly across the brain (spreading)
(Note: occurs rom visual cortex not the eyes)
Describe the trigeminovascular pathways that causes migraine
Increase in serotonin causes BV on the dura to vasodilate
This causes a release of neuropeptides
This begins a cascade reaction causing further inflammation: particularly release of CGRP: potent vasodilator
CGRP activate the nerve pathways & the nerves send pain signals to the trigeminal ganglion
The trigeminal ganglion, once activated by CGRP, is what causes peripheral sensitisation which is responsible for the throbbing pain in a migraine
Trigeminal ganglion transmits pain impulses to SpV (spinal trigeminal nucleus caudalis)
SpV then relays to the thalamus and from the thalamus to the cerebral cortex where pain is decoded
Describe the difference between peripheral and central sensitisation that occurs during migraine pathophysiology [2]
come back x
Peripheral sensitisation:
* Sensitization of peripheral trigeminovascular neurons in the trigeminal ganglion mediates the throbbing pain
Where is the trigeminal ganglion found? [1]
Trigeminal ganglion located just above the roof of the mouth
Where do acute [1] and chronic [1] treatments for migraines target?
Acute:
Acute medication given for migraine primarily acts peripherally, at the trigeminal ganglion
Preventive medication for migraine acts more centrally (i.e. the trigeminal nucleus caudalis)
What drug classes are used to acutely treat migraine? [3]
Triptans: (5HT1D/B agonists)
* Vasoconstrictive Agents
Ditans (5HT1F agonists)
* Neurally Active Anti-Migraine Agent
Gepants: small molecule CGRP receptor antagonists
Describe MoA of triptans [1]
Where are 3 possible sites of action? [3]
Triptans:
* 5-HT1D/B agonists.
* 3 possible sites of action: 1. cranial vasoconstriction, 2. peripheral neuronal inhibition and 3. inhibition of transmission through second order neurones of the trigeminal ganglion.
Name first line treatment for migraine? [1]
Sumatriptan
Describe action of CGRP monoclonal antibodies (mAbs)
Prevent vasodilation
What is the role of CGRP and when is it released? [1]
CGRP is a potent vasodilator released from the meninges in response to increased serotonin-induced vasodilation in the premonition phase of a headache.
Which of the following is a cluster headache?
A
B
C
D
E
Which of the following is a cluster headache?
A
B
C
D
E
