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Flashcards in Headache Deck (48)
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1

Int'l hadache society classification

Primary- headaches without identifiable structural cause

Secondary- headaches with underlying cause

2

Pathophys of headaches, general

Inflammation or physical traction of pain sensitive nerve fibers

3

Pain sensitive structures in the head:

- Dura and meninges
- Large Arteries at the base of the brain, meningeal arteries
- Venous sinuses
- Scalp muscles
- Upper Cervical muscles
- Periosteum of the skull
- Facial and head structures/organs, skin, eyes, teeth, sinuses, muscles etc...

4

Brain parenchyma has sensory receptors T or F?

False. Brain parenchyma has no receptors and is insensitive to pain.

Most of the pain sensitive structures lie in the dura/meninges and/or are large to medium sized arteries that lie in the back of the brain

5

Stimulation of cranial pain receptors carried by what nerve troots?

V. VII, IX, X and the upper cervical nerve roots C2-3

mostly 5,9, c2-3

6

The opthalmic branch of V innervates pain sensitive structures where

Anterior and Middle Fossa and the anterior half of the skull. Includes the tentorium

7

POsterior scalp and neck

C2-3

8

CN IX and X

Posterior fossa

9

Some common migraine features

frequently unilateral
-Pulsating
- 4-72 hours
- nausea with or without vomitting
- May be preceded by a prodromal phase
- May be preceded by an aura
- Triggers or precipitating factors are frequent
- Frequent family history

10

Migraine Prodrome

Experienced by approximately 40% or migraineurs
- a vague constellation of symptoms that include mood swings
odd food cravings
malaise or vague feeling of unwellness
fatigue
muscle aches and stiffness

11

Migraine aura

Usually a visual disturbance that precedes the headache by no more than 60 minutes. Begins near the center of the visual field as a small gray area with indefinite boundaries. During the next few minutes, the gray area slowly expands into a horseshoe with zigzag lines and expands out toward the periphery of the visual field

12

What percentage of migraineurs have clearly defined auras?

only 20%

13

Women affected 2-3 times more frequently than men by migraines

ok

14

Migraine carries strong family hx

ok

15

Familial hemiplegic migraine?

inherited genetic abnormalities at several different loci... dominant gene

16

Trigeminovascular system?

anatomical substrate for migraines
- Involves CN V1 innervation of pain receptors located in the dura, meninges, and medium/large cerebral arteries and veins that lie on the surface of the brain and above the tentorium.

17

Know Dermatomes of the faceo

ok

18

Slide 21

Nuclues caudalis of trigeminal system projects afferent pain sensation from the face to the VPM of the Thalamus which is then sent to sensory cortex

19

What is responsible for mediating the vascular changes associated with migraines?

Trigeminovascular system- AFFERENTS come from the vasculature running through the Dura Mater which comes back to the Trigeminal nucleus. EFFERENTS then come from the superior salivatory nucleus then cause vascular changes (vasodilation)

20

The vasodilation associated with migraine headaches is mediated by:

Superior salivatory nucleus which carries parasympathetics along CN VII

21

What is the current thinking on Migraine pathogenesis

It is due to polygenic predisposition that hypersensitizes both the peripheral (trigeminovascular- afferent and efferent) and central (nucleus caudalis, etc..) pathways of heahache.

- May be triggered by central causes or external causes.
- Neurogenic inflammation of meningeal vasculature

22

What is the most common aura

visual scintillations followed by scotoma or blind spot.

23

Where do aura's usually arise from in the brain?

Cortex- triggered either remotely from a central brain stem genearator or locally by a variety of external stimuli

24

Clinical manifestations of an aura depend on...

What part of the brain is being excited

25

Visual auroa due to excitation of which part of the brain?

calcarine cortex

26

What happens to bloodflow during an aura?

Blood flow in the area of excitation briefly increases in concert with the excitation, then decreases which gives way to the transient loss of vision in this area.

27

What are the two neurotransmitters that are important in the pathogenesis of neurogenic inflammation/pain and migraine

Calcitonin gene related peptide and substance p.

CGRP and SP

28

Know that sensory (afferent) systems can also sometimes function as an efferent system sending action potentials to the nerve terminals where Neurotransmitters are released. CGRP and SP have potent vasodilator properties among other functions

ok

29

SLIDE 28

KNOW

30

What do triptans do

They are 5-HT1 receptor agonists. Remember 5-HT is serotonin. As 5-HT1b-d receptor agonists, they inhibit the release of CGRP