The Case Of The Hot Sore Head

Question 1

Pain sensitivity of cranial structures

Answer 1

Question 2

CNS structures involved in modulating pain

Answer 2

Question 3

Headache classification

Answer 3

Question 4

Migraine definition

Answer 4

Brain disorder caused by altered regulation (neurotransmitters) due to dysfunction of central brain stem functions, and therefore control of sensory afferents (pain sensitive structures)

Question 5

Brain disorder caused by altered regulation (…) due to dysfunction of central brain stem functions, and therefore control of sensory afferents (… … structures) = …

Answer 5

Brain disorder caused by altered regulation (neurotransmitters) due to dysfunction of central brain stem functions, and therefore control of sensory afferents (pain sensitive structures) = MIGRAINE

Question 6

Phases of migraine

Answer 6

Prodrome
Aura
Migraine attack
Postdrome

Question 7

Predisposing factors for migraine - genetic mutation?

Answer 7

Genetic - rare single gene mutations causing familial hemiplegic migraines

Question 8

Prodrome of migraine - 3 categories?

Answer 8

Fatigue/cognitive change
Homeostatic alterations
Sensory sensitivities/non-painful migraine symptoms

Question 9

The … can often be viewed as the “Generator” of migraine - homeostatic alterations

Answer 9

Hypothalamus

Question 10

Activation of brain stem can lead to what symptom in Prodrome of migraine?

Answer 10

Nausea

Question 11

Increased sensitivity of TCC leads to …

Answer 11

Neck stiffness

Question 12

Increased ADH secretion leads to ..

Answer 12

Thirst/urination

Question 13

Aura of migraine - 3 types of symptom in aura

Answer 13

Visual - zig-zag lines, visual fortification
Speech - dysphasia
Sensory disturbance - negative and positive symptoms
Some have aura without migraines, others have migraine without aura
Aura is not necessary prior to a migraine - cortical spreading depression is just one component of the migraine attach

Question 14

Initiation of CSD - migraine

Answer 14

CSD is caused by large amounts of extra cellular potassium and glutamate secretion
Interaction between hypothalamus, thalamus and the brain stem nuclei release neuromodulators to trigger CSD
Oral preventatives for migraine e.g. Topiramate, amitriptyline, propranolol are used to stop this process

Question 15

Diagnostic criteria for migraines

Answer 15

Question 16

Phenotype the headache

Answer 16

Presenting - constant or episodic, site: unilateral or bilateral, headache load: frequency/duration/severity
Character of pain - throb, stabbing
Precipitating factor
Previous history of headache

Question 17

Seretonergic pathway - pain

What level of serotonin is associated with migraine

Answer 17

Low levels of serotonin are associated with migraines

Question 18

What is used to treat migraine

Answer 18

Sumatriptan - act on trigeminal nerves at 5HT1d + 1f receptor
Prevent release of other neurotransmitters which drive pain
Binds to 5-HT1b on blood vessels - causes vasoconstriction - uncontrolled HTN or angina etc be careful

Question 19

Dopaminergic pathway - bothersome symptoms in migraine

Answer 19

Dopamine hypersensitivity leads to the associated symptoms of migraine which include:
N+V
Yawning

Question 20

Dopamine … leads to the associated symptoms of migraine which include:
N+V
Yawning

Answer 20

Dopamine hypersensitivity leads to the associated symptoms of migraine which include:
N+V
Yawning

Question 21

Dopamine hypersensitivity leads to the associated symptoms of migraine which include:
..+…
Yawning

Answer 21

Dopamine hypersensitivity leads to the associated symptoms of migraine which include:
N+V
Yawning

Question 22

Dopamine hypersensitivity leads to the associated symptoms of migraine which include:
N+V
…

Answer 22

Dopamine hypersensitivity leads to the associated symptoms of migraine which include:
N+V
Yawning

Question 23

Neurotransmitters - trigeminal nerve

Answer 23