Pain Associated with the Head Flashcards
Describe the process of a migraine
When trigeminal system activated
Peptides are released
Promoting inflammation reaction
= increases flow of sensory traffic through the brain stem
What is the trigeminal nerve?
5th cranial nerve
What are the 6 causes of headaches?
Traction/dilation of intra/extracranial arteries
Traction of large extracranial veins
Compression, traction or inflammation of cranial + spinal nerves
Spasm + trauma to cranial + cervical muscles
Meningeal irritation + raised intracranial pressure
Disturbance of intracerebral serotonergic projections
Describe role of serotonin
Neurotransmitter
Mediator of migraines
What are the 4 types of headaches?
Sinus
Cluster
Tension
Migraine
What is a sinus headache?
Pain is usually behind the forehead + cheekbones
What is a cluster headache?
Pain is in + around one eye
What is a tension headache?
Pain is like a band squeezing the head
What is a migraine?
Pain, nausea + visual changes are classic form
What is the frequency for a tension headache?
Chronic
Often daily
What is the duration of a tension headache?
30mins-7 days
Where are tension headaches located?
Both sides
Whole head + neck
What is the pain of a tension headache?
Mild-moderate
Pressure
Tightness
What symptoms will not be present with tension headache?
Nausea + vomiting
Photophobia
Phonophobia
What is the frequency for a migraine?
1-2/year
2-3/week
What is the pain of a migraine?
Moderate-severe
Pulsating
Throbbing
What is the duration of a migraine?
4hrs-3days
What is the location of a migraine?
Usually one sided
(BUT can swap between attacks)
What are the symptoms of migraines?
Aura
Nausea, vomiting
Sensitive to light, sound + smell
How many stages is there of a migraine?
4
Prodrome
Aura
Headache
Postdrome
What happens in Prodrome (stage 1)?
Days before actual pain
Light + sound sensitivity, depression, irritability + lack of appetite
What happens in Aura (stage 2)?
One hour prior
Changes in visual perception
Seeing flashing lights + geometric patterns
Temporary loss of half of visual range
What happens in Headache (stage 3)?
Moderate-severe pain
Up to 3 days
Also intolerance to light + noise, nausea + vomiting, sensitivity to movement + speech difficulties
What happens in Postdrome (stage 4)?
Last for several days after
Irritable + fatigued
Scalp tender
What can be some migraine triggers?
Foods - spices, wine
Food additives
Sleep
Stress
Female hormones
Family history
Medication
Noise, light
What is the main difference between a tension headache + migraine?
Aura
Vomiting
Aggravated by activity
What type of symptoms can be experienced in the migraine Aura?
Positive neurological - additional - eg. visual flashes
Negative neurological - loss - eg. blind spots, numbness
What is the pain of cluster headaches?
Excruciating
Penetrating, boring, non-throbbing
What is the duration of cluster headaches?
15mins-3hrs
Same time each day
What is the location of cluster headaches?
Always the same side
What are the symptoms of cluster headaches?
Watering eyes
Nasal stuffiness, runny nose
Red eye, swollen eyelids
Sweating
What is trigeminal neuralgia?
Intense, sharp, burning pain
On one or both sides of face
Where is trigeminal neuralgia normally distributed?
Along one or more of somatic sensory branches
What are the causes of trigeminal neuralgia?
Pressure from blood vessel
Demyelination of nerve
Pressure from tumour
Pressure damage to nerve
What are the branches of the trigeminal nerve?
Ophthalmic nerve (CN V1)
Maxillary nerve (CN V2)
Mandibular nerve (CN V3)
What is the mechanism of action of triptans?
Serotonin 5HT 1B/1D receptor agonists
Describe triptans anti-migraine action
- vasoconstriction
- trigeminal inhibition
- decreased pain transmission
What are the mechanisms included in the triptans for migraines?
Intracranial vasoconstriction
Inhibition of neurotransmission in trigeminocervical complex
Inhibition of release of pro-inflammatory + vasoactive mediators
