headache Flashcards
what is the one year prevalence of headache disorders? what percentage do neurologists end up seeing?
50%
20% seen by docs
what are the 3 types of primary headaches?
migraine
cluster headache
tension-type headache
what is a secondary headache? i
headache cause by another condition/ disorder local or systemic. (may be serious causes: rarer than primary)
after what time frame is a headache characterised as a long lastin one?
> 4h
which headaches are long lasting?
migraine and tension type and medication overuse headache
what are the the short lastin headaches?
cluster headache
other name for cluster headache
trigeminal autonomic cephalagia
what is medication overuse headache
You have headache, you start taking a medication for 3/ week or more: you have a medication overuse headache
which patients do you give a diagnostic test to?
only the ones you suspect may have secondary headache after either
1) seeing a red flag in their history/ examination or
2) red flag after giving them preliminary primary headache diagnosis
what are the main red flag areas suggesting secondary headaches?
NOSA
neurological signs (focal neurology, swollen optic discs)
onset (abrupt really quick)
systemic symptoms (fever neck stiffness)
age (New onset or different headaches in a person >50yrs)
what do these symptoms suggest: Confusion, impaired consciousness, focal neurology (limb related neurology problem: stroke common) , swollen optic discs? (what cetgory of red flag?)
neurological, suggest intercranial pressure, encephalopathy
Fever, neck stiffness, rash, weight loss, (symptoms in lower limbs if youre a teen or young) what fo they suggest and what category are they?
meningitis, systemic
Sudden, abrupt onset of a severe headache (thunderclap headache: they feel like they have been kicked in the back of the head 10/10 pain, onset in less than a minute
brain bleed, onset
what is a headache practically (why/ how does your head hurt?)
due to activation of the trigemino-vascular system (trigeminal nerve)
where/how does the whole pathophysiology axis start?
abnormal function of some area in brainstem (hypothalamus, PAG ect) (due to some excitation)
what does this abnormal brainstem funstion lead to?
cortical spreading depression
what is happening physiologically in cortical spreading depression? what are the symptoms?
Abnormal cortical hyperexcitability
(Ca++, Glu, ¯Mg++)
you see auras
what is central sensitization and what triggers it? what is the result?
when your start being too sensitive to one/ some of your senses due to the tgvs activation, which further stimulates your headache
what is CGRP? what causes its secretion? what does it do?
It is a peptide released by the body in response to activation of TGVS.
it causes vasodilation and neurogenic inflammation
which leads to pain perpetuation and more TGVS activation.
when are migraines considered episodic and when a chronic disorder?
chronic when more than 10-15 a month
characteristics of a migraine pain- location, quality, intensity, trigger, duration
-unilateral location
- pulsating quality
- moderate to severe pain (disrupts your task at hand)
-aggrevation by routine physical activity
-last hours and sometimes days
what are the other symptoms of migraine (people usually get 1 or more of these)
one of these
nausea and/ or vomiting
photophobia and/or phonophobia/ osmophobia
+
extra
(+/- auras )
what is an aura? hoe long does it last? when does it happen usually in relation to headache onset?
complex array of symptoms reflecting focal cortical or brainstem dysfunction
5-30 mins
usually before headache
what are two specific pattern types of auras?
elemental visual distur bance (bean shape increasing over roughly 10 mins)
expanding Cs (same: incr size over 8 mins)
