29 - Headaches

Question 1

Are headaches more common in males or females?

Answer 1

3:1 females

Question 2

Where is first synapse for neurons that transmit headache pain?

Answer 2

trigeminal nucleus caudalis (a subdivision of spinal nucleus) and dorsal horn of upper cervical spine

Question 3

Where is second synapse for neurons that transmit headache pain?

Answer 3

in VPM or VPL

Question 4

Where is genetic polygenic loci for headaches located?

Answer 4

10q23

Question 5

What is the trigeminovascular system?

Answer 5

cortical spreading depression stimulates brainstem generator to stimulate efferent signal of trigem ganglion which then releases SP and CGRP onto CRL receptors of artery, causing vasodilation, inflammation, nd mast cell degranulation.
Afferent signals pass back through trigem nerve to brainstem.

Question 6

How does a migraine develop?

Answer 6

triggers–>central generator (brainstem)–>aura(corticol)–>neurogen inflammation (trigeminovascular) –>central pain (thalamus,cortex,limbic,parasymp)

Question 7

What is the aura of a migraine?

Answer 7

represents decompression wave from calcrine region forward. usually materializes as a visual grey ring of jagged lines

Question 8

What are the two important neurotransmitters of the trigeminovascular system?

Answer 8

CGRP and SP

Question 9

What are the subtypes of serotonin receptors?

Answer 9

5-HT1b-vascular terminals (B for blood)
5-HT1d - peripheral trigeminal nerves (d for distal/periphral)
5-HT 1B/D/F combo on central synapse of trigem nerve

Question 10

What are CGRP antagonists?

Answer 10

gepants

Question 11

What are cluster headaches?

Answer 11

chronic recurring headaches. Pain always unilateral frontal or retro-orbital with possible unilateral horners or lacrimation.
triggered by alcohol and tobacco
treat with nasal oxygen or subcu sumatriptan.
prevent with Ca channel blockers (verapamil)

Question 12

What are tension headaches?

Answer 12

bilateral and bandlike pain. no auras or N/V. Only last about 3 hours. If 15 then chronic

Question 13

What is idopathic intracranial hypertension?

Answer 13

pseudotumor cerebri.
an emergency that can result in permanent vision loss. Papilledema and varying character headache with transient visual obstructions.
9:1 females. Usually related to abnormalities that alter CSF absorption. (hypervitaminosis A, tetracytline or steroid withdrawal) Could also be due to blockage.

Question 14

How do you treat idiopathic intracrainial hypertension?

Answer 14

reduce CSF production with acetazolamide and furosemide.

Repeat LPs to decrease volume

Question 15

What is giant cell arteritis?

Answer 15

temporal arteritis. Autimmune systemic vasculitis of small/medium arteries.
Unilateral headache, monocular visual obstruction, polymyalgia rheumatica with jaw claudication in half.
ESR elevated in 75%.
Confirm diagnosis with temporal artery biopsy

Question 16

Patient presents with unilateral headache, monocular vision obsturction and elevated ESR. How should you treat?

Answer 16

immediate corticosteroids while you confirm it is giant cell arteritis