The Case Of The Hot Sore Head Flashcards
Pain sensitivity of cranial structures
CNS structures involved in modulating pain
Headache classification
Migraine definition
Brain disorder caused by altered regulation (neurotransmitters) due to dysfunction of central brain stem functions, and therefore control of sensory afferents (pain sensitive structures)
Brain disorder caused by altered regulation (…) due to dysfunction of central brain stem functions, and therefore control of sensory afferents (… … structures) = …
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
Phases of migraine
Prodrome
Aura
Migraine attack
Postdrome
Predisposing factors for migraine - genetic mutation?
Genetic - rare single gene mutations causing familial hemiplegic migraines
Prodrome of migraine - 3 categories?
Fatigue/cognitive change
Homeostatic alterations
Sensory sensitivities/non-painful migraine symptoms
The … can often be viewed as the “Generator” of migraine - homeostatic alterations
Hypothalamus
Activation of brain stem can lead to what symptom in Prodrome of migraine?
Nausea
Increased sensitivity of TCC leads to …
Neck stiffness
Increased ADH secretion leads to ..
Thirst/urination
Aura of migraine - 3 types of symptom in aura
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
Initiation of CSD - migraine
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
Diagnostic criteria for migraines
Phenotype the headache
Presenting - constant or episodic, site: unilateral or bilateral, headache load: frequency/duration/severity
Character of pain - throb, stabbing
Precipitating factor
Previous history of headache
Seretonergic pathway - pain
What level of serotonin is associated with migraine
Low levels of serotonin are associated with migraines
What is used to treat migraine
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
Dopaminergic pathway - bothersome symptoms in migraine
Dopamine hypersensitivity leads to the associated symptoms of migraine which include:
N+V
Yawning
Dopamine … leads to the associated symptoms of migraine which include:
N+V
Yawning
Dopamine hypersensitivity leads to the associated symptoms of migraine which include:
N+V
Yawning
Dopamine hypersensitivity leads to the associated symptoms of migraine which include:
..+…
Yawning
Dopamine hypersensitivity leads to the associated symptoms of migraine which include:
N+V
Yawning
Dopamine hypersensitivity leads to the associated symptoms of migraine which include:
N+V
…
Dopamine hypersensitivity leads to the associated symptoms of migraine which include:
N+V
Yawning
Neurotransmitters - trigeminal nerve
