L19: Headache Flashcards
What is a headache?
The most common symptoms related to the CNS
Most adults (75%) report one or more headaches per year
Chronic headache (more than 15 days for 3+ months) affects 2% of the population
Headache disorders are the 6th highest cause of disability worldwide.
Why does the head hurt?
It is not the actual brain that hurts, it is the sensation of the face, scalp, meninges, and cerebral blood vessels.
Meninges and blood vessels above the cerebellar tentorium are innervated by CN 5 (trigeminal nerve)- first division
Meninges and blood vessels below the cerebellar tentorium are innervated by cervical nerves C1-C3
Innervation of the posterior scalp is largely from the greater occipital nerve (C2-C3)
Innervation of the forehead is largely CN 5 (trigeminal and this is why many headaches result in forehead pain
What is the ICHD- version 3 classification of the primary headaches? What does ICHd stand for?
International classification of headache disorders
Migraine: with or without aura, chronic migraine
Tension type headache
Trigeminal autonomic cephalalgias: cluster headache, paroxysmal hemicrania, SUNCT
What are secondary headaches?
Caused by underlying cause (injury, hemorrhage, clot, tumor), physical disruption in parts of the brain that feel pain
Intracranial hemorrhage, subarachnoid hemorrhage, neoplasm
What is an intracranial hemorrhage? What is a subarachnoid hemorrhage? What is a neoplasm?
IH: Skull fracture or head injury that pushes/stretches (pressure), and also blood in the brain stings
SAH: aneurysm ruptures and bleeds into brain quickly (high cardiac output), symptoms similar to migraine at start but much more serious
Neoplasm: tumor (cerebellar) produces pain in back of head, starts as mild headache that will not go away, accounts for <1% of headaches
What is a tension type headache?
Most common type of headache, may be related to muscle contraction, headache is typically milder and bilateral and lasts hours to days
May be episodic or chronic
What are primary headache disorders?
Headaches that have no other recognizable cause for the headache.
Three most common types: tension-type headache, migraine (with and without aura), cluster headache
What are the four stages of a migraine?
Early symptoms (mood, fatigue, food craving, cognitive changes, yawn, neck stiff)
Aura
Headache (severe, throbbing pain, nausea, phobias)
Resolution (fatigue, cognitive changes, neck stiff, postdrome)
What are the 5 criteria of a migraine?
A. At least 5 attacks w/ criteria B-D
B. Attacks lasting 4-72 hours (untreated or successfully treated)
C. Has at least 2 of the following criteria: unilateral, pulsating, moderate/severe pain intensity, aggravation by or causing avoidance of routine physical activity.
D. During headache at least 1 of the following: nausea/vomiting, photophobia/ phonophobia
E. Not better accounted for by another ICHD-3 diagnosis
A is the most important criteria
What is the definition of a migraine?
Complex brain network disorder with dysfunction in sensory processing with superimposed genetic predisposition
What are premonitory symptoms?
Precede headache by up to 72 hours, changes in mood/ activity, irritable, fatigue, food cravings, yawn, stick neck, phobias
May continue into headache and postdrome phase
Presumed triggers include sleep deprivation, hunger, bright light
Changes in brain activations occur in early premonitory phase, and show increased regional cerebral blood flow
What is involved in the aura phase?
1/3 of migraine patients experience this
1 or more transient, fully reversible neurological deficits that develop over 5 mins or more and last between 5-60 mins
Visual aura: most common in 90% of cases, may show positive (fortification spectra), negative (scotoma), and other deficits that include sensory, motor, speech, brain stem and retinal aura symptoms
What is involved in cortical spreading depression?
Happens in the aura phase, depolarization of brain in wave pattern, unique to mammalian brains, starts at back and moves forward (visual, sensory, motor in that order)
Can be positive or negative
Spreads from one brain regions to others
What is familial hemiplegic migraine?
Genetic channelopathy, hemiplegic aura may last up to 72 hours, due to three main channels
CACNA1A: calcium channel gene disorder, 1st discovered, FHM #1
ATP1A2: sodium potassium ATPase in astrocyte, 2nd found
SCN1A: sodium channel, also causes epilepsy, last found
What is involved in the headache phase?
Lasts between 4-72 hours, pulsatile and unilateral (moderate to severe intensity, made worse with activity)
Accompanied by nausea, photophobia, phonophobia
