Headache Flashcards
What are the two main classifications of headaches?
Primary headaches and secondary headaches.
What are the primary types of headaches?
Migraine, tension-type headache, trigeminal autonomic cephalalgias, and other primary headaches.
What are the secondary types of headaches?
Headaches attributed to trauma, vascular disorders, infections, substance withdrawal, homeostasis disorders, and psychiatric conditions.
What is the most common primary headache?
Tension-type headache (TTH).
What is the pathophysiology of headaches?
Activation of pain-sensitive structures in the head, mediated by the trigeminal and upper cervical nerves.
What neurotransmitters play a role in headache pain transmission?
Glutamate, substance P, calcitonin gene-related peptide (CGRP), and neurokinin A.
What are the diagnostic criteria for migraine?
Headache lasting 4-72 hours with at least 2 of the following: unilateral location, pulsating quality, moderate/severe intensity, or worsening with physical activity. Plus nausea/vomiting or photophobia/phonophobia.
What is the difference between migraine with and without aura?
Migraine with aura includes transient neurological symptoms (e.g., visual disturbances) before headache onset, while migraine without aura lacks these symptoms.
What are common migraine triggers?
Stress, altered sleep patterns, skipping meals, bright lights, hormonal changes, alcohol, and certain foods.
What is the first-line symptomatic treatment for migraine?
NSAIDs (naproxen, diclofenac), acetaminophen, and triptans (sumatriptan, zolmitriptan).
What is the mechanism of action of triptans?
Selective 5-HT1B/1D receptor agonists that constrict intracranial vessels and inhibit pain pathways.
What are the prophylactic treatment options for migraine?
Beta-blockers (propranolol), antiepileptics (valproate, topiramate), antidepressants (amitriptyline), and CGRP monoclonal antibodies (erenumab, fremanezumab).
What is status migrainosus?
A severe migraine attack lasting more than 72 hours, requiring medical intervention.
What is a tension-type headache (TTH)?
A headache with a bilateral, pressing or tightening quality, mild to moderate intensity, and not aggravated by routine activity.
How is episodic TTH different from chronic TTH?
Episodic TTH occurs less than 15 days per month, while chronic TTH occurs at least 15 days per month for more than 3 months.
What are effective treatments for tension-type headaches?
Simple analgesics (acetaminophen, aspirin, NSAIDs) and stress management techniques.
Why are opioids not recommended for TTH?
Risk of medication overuse headache and dependency.
What are trigeminal autonomic cephalalgias?
Strictly unilateral headaches with prominent autonomic symptoms (lacrimation, rhinorrhea, ptosis, conjunctival injection).
What are examples of trigeminal autonomic cephalalgias?
Cluster headache, paroxysmal hemicrania, SUNCT (short-lasting unilateral neuralgiform headache with conjunctival injection and tearing), and SUNA.
What is a cluster headache?
A severe unilateral headache lasting 15-180 minutes, occurring in clusters over weeks to months, with autonomic symptoms.
What are the characteristic symptoms of cluster headache?
Severe orbital pain, lacrimation, nasal congestion, conjunctival injection, and ptosis on the affected side.
What are the diagnostic criteria for cluster headaches?
Severe unilateral orbital, supraorbital, or temporal pain lasting 15-180 minutes, with at least one autonomic symptom.
What is the first-line acute treatment for cluster headache?
Subcutaneous sumatriptan and high-flow oxygen therapy.
What is the first-line prophylactic treatment for cluster headache?
Verapamil, with ECG monitoring due to potential cardiac effects.
