Headache- migraine, cluster and tension Flashcards
what are the 3 forms of migraine attacks?
pain
focal symptoms
pain and focal symptoms
what are the common characteristics of those who have migraine disorder?
- Tendency to repeated attacks
- Triggers
- Easily hung over
- Visual vertigo
- Motion sickness
what are the phases of a migraine?
prodrome
aura
headache
resolution
recovery
what happens during prodrome?
- Changes mood, urination, fluid retention, food craving, yawning
what happens during aura phase?
- Visual
- Positive & -ve symptoms together( scintillation and blindspot)
- Sensory (numbness/ paraesthesia)
- Weakness
- Speech arrest
what are the symptoms on the headache phase?
- Head and body pain
- Nausea
- Photophobia
what needs to be done during the resolution phase?
sleep and rest
what occurs during the recovery phase?
- Mood disturbed, food intolerance, feeling hungover
what is the treatment for an acute attack?
- Aspirin/ ibuprofen (non-steroidal) and paracetamol and metoclopramide (anti-emetic)
- Soluble preparations to aid absorption
- Triptan tablets, melts, nasal sprays, S/C injections (vasoconstrictors)
- Synergise with NSAIDS
- Hit headache hard and fast
- Opiate caution-analgesic abuse potential
- Short nap
- TMS
- Interrupts complex networks that trigger and perpetuate migraine
- Migraine Caused by spreading electrical depression across cerebral cortex
- Interrupts complex networks that trigger and perpetuate migraine
what lifestyle issues are present in those with migraines?
- Sensitive heads even between attacks
- Over-react to stimulation
- Cannot ignore world around them – overstimulated their brains
what triggers can cause a migraine attack?
- Dietary, environmental, hormonal, weather, dehydration, stress
- Drink >2L water/ day
- Avoid caffeine
- Do not skip meals
- Don’t oversleep/ late nights
- Analgesic abuse
what can be used for migraine prophylaxis?
- Over counter preparations
- Magnesium, coenzyme Q10, riboflavin, feverfew
- Tricyclic antidepressants
- Amitriptyline
- Beta blockers- propranolol, atenolol (dec BP and pulse)
- Serotonin antagonists- pizotifen
- Calcium channel blockers- verapamil
- Anticonvulsants- gabapentin, valproate (cannot get pregnant while taking this medication)
- Greater occipital nerve blocks
- Botox
- Suppression ovulation (progesterone only pill/ implant/ injection)
- Cant use combine and oestrogen can stimulate headache
- Erenumab
what is erenumab?
- Injectable drug
- Cut number days people had migraines in half
- Monoclonal antibody
- Disables calcitonin gene-related peptide or its receptor (CGRP antagonists)
- Use for Episodic migraine, chromic migraine, or cluster headache
what is the treatment for tension type headaches?
- Tight muscles around head and neck bilaterally
- NSAIDs preferred
- Ibuprofen, naproxen, diclofenac
- Paracetamol
- Tricyclic antidepressants
- Amitriptyline
- SSRIs less effective
- Biofeedback and relaxation unproved
what is a cluster headache?
severe unilateral pain lasting 15-18 mins untreated
- Classified as trigeminal autonomic cephalgia
- At least one of following ipsilaterally
- Conjunctival redness and/or lacrimation
- Nasal congestion and/ or rhinorrhoea
- Eyelid oedema
- Forehead and facial sweating
- Mitosis and/or ptosis
- Sense restlessness/ agitation
- Frequency between one on alternate days to 8 per day
- Not associated with brain lesion on MRI
what is the difference between an migraine and cluster headache?
