Headaches

Question 1

What are common primary headaches?

Answer 1

Sinus, Cluster (one eye), Tension (band squeezing on head), Migraine (pain, nausea and visual changes)

Question 2

What are secondary headaches?

Answer 2

Meningitis (fever, neck rigidity, photophobia)
Subarachnoid haemorrhage (thunderclap headache, neck pain)
Sinus headache
Brain tumours - worse in the morning

Question 3

What are some triggers of tension headaches?

Answer 3

Alcohol use, caffeine, eye strain, excessive smoking, fatigue

Question 4

What are the 4 stages of a migraine attack?

Answer 4

Premonitory/Prodrome stage
Aura stage ( unilateral numbness, transient visual disturbances, dizziness)
Headache stage ( activation of trigeminal nerves releases neuropeptides. Serotonin cause vasoconstriction at nerve endings.
Postdrome (tired, unable to concentrate, weakness, nausea

Question 5

What is an example of treatment of migraines?

Answer 5

Triptans. Bind to 5-HT1B and 5-HT1D receptors.
Causes vasoconstriction of intercranial extracerebral arteries.
Inhibits nociceptive transmission within the trigeminal nerve in the brainstem and upper spinal cord
Inhibits release of CGRP, neurokinin A and Substance P.
Analgesics (NSAIDs and Paracetamol)
Ergot alkaloids - not used for the prevention of migraine.

Question 6

What are some important questions to ask patients when taking a history?

Answer 6

Where is the pain located, when did the pain begin, what is the quality of the pain, what is the severity of the pain, does the pain radiate, have you experienced this type of pain in the past.

Question 7

What are 3 agents that are used to prevent recurrent migraine attacks?

Answer 7

Clonidine - agonist at alpha 1 and 2 (vasodilation)
Beta-blockers -modulation of adrenergic or serotonergic neurotransmission
Anti-seizure drugs
Antidepressants
Opioids