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Flashcards in Headaches! Deck (19)

What are Primary Headaches?


HA without intracranial Pathology (like tumors etc) 




Definition of Migraine and Pattern for Migraine

3 Types of Migraine:

Migraine = HA + Autonomic symptoms; often associated with depression, anxiety, insomnia etc 

Pattern = Acute and Recurrent, severe, unilateral or bilateral, relieved with sleep, pulsating pain, can have photophobia and phonophobia and nausea


Migraine with Aura

Migraine without Aura

Complicated Migraine


What is cutaneous allodynia?

Skin hurts when its not supposed to!!!


Means that pain/headache has gone from easily treatable peripheral condition to hard to treat central condition


RACE against the clock to prevent this! 


Criteria for migraine without aura?

2 of the following:

- unilateral

- pulsating pain

- nausea



BOTH of the following: 

- similar pain in past

- no organic disease 


What is a complicated migraine?

Migraine with the following:

- Hemiplegic - neuro findings of weakness etc

Opthalmoplegic - double vision

Basilar Artery Migraine - problems with balance, almost like a stroke

Alice in Wonderland - perceive things as big/small 




What is a tension-type HA?

Often bilateral

Squeezing pain - worse as day goes on 

Less severe than migraine




Causes of Secondary HA?




Acute hemorrhage (like Sub-Arachnoid Hemorrhage) 


Pattern for secondary HA from Tumor

Chronic Progressive pain

worse in morning (ICP increased) 

Exacerbated by valsalva 


HTN as a cause of secondary HA?

Features? Causes?

Rare, if real think brain, kidney, thyroid, drugs or tumors secreting vasoactive substances to cause it 

--> usually secondary to pain 

*Malignant HTN can lead to dysregulation of BBB and cause HA (but little increase in BP not going to cause HA)


Primary Intracranial HTN = Pseudotumor 

- can cause tumor pattern  (chronic progressive pain worse in AM)

- Papilloedema


Presentation of Acute Hemorrhage?

Thunderclap HA usually from a slow vessel leak that then bursts (aneurysm in head that blows - can kill you!!)


Neck stiffness - blood in neck

Low fever

GET a CT (bc fast) and then LP which can also help relieve pressure


Other secondary causes of HA?



Primary Intracranial HTN

Chiari Malformation - cerebellar herniation that occludes spinal canal but rarely causes HA and more likely causes intermitten neurological hands/feet symptoms 


Red Flags for secondary HA?


Systemic symptoms - weight loss, stop mensturating

Neuro symptoms 

Onset - rapid or chronic

Older - (pts >40) 

Previous HA history is different 


Whta is Chronic Daily HA and how does it present?




>15 HA /month and >4 hours a day 

Get adjunct symptoms from having HA all the time: Anxiety, depression, insomnia 




Type of Chronic Daily HA and Presentations? 

Transformed Migraine - Migraines that occur closer and closer together; harder to prevent spike/onset of migraine bc already have baseline of HA symptoms


Chronic Tension-Type HA = HA moving closer and closer togeter, same pattern but no migraine spikes bc never had them in the first place


New Persistent Daily HA - new chronic HA without history of TT or migraine - BAD


Physiology of HA?

Genetic Predisopsition + Stimulus (internal - stress or external - light) lower thresholds for HA

*Decreased serotonin in Medium Dorso Raphenucleus and Trigeminovascular System opens the 5Ht1-D receptor gate and allows inflammatory cytokine soup to be released from brain - PG, Histamines, Subs P


Meninges get inflamed = HA 


STrategy for Medicine? 



Acute HA treatment regimes?


rescue Meds?

PG inhibiters and Antihistamines - work on the soup that's there

5-HT agonists = Triptans - help to close gate and stop acute mediators of inflammation and put 5-HT back to close the gate 


Adjuncts: Antiemetics and anxiolytics


Rescue Meds (once cutaneous allodynia has already happened)

- DHE, Opioids, Reglan, Odansentron (antiemetic, serotonin antag) 


What are the different triptans? 

Sumatriptan - quick in and out

Zolmitriptan - good tastes, easy to administer


Rizatriptan - need for GI absorption, placebo?

Naratriptan - Long acting - good for recurrence problems and used for Menstrual migraines 


Dihydroergoatamine (IV) -DHE different mechanism and can be used as rescue 


Drugs for prevention of mirgrains? 


Amitriptyline - TCA, SNRI anti-depressant also can be used for chronic or neuropathic pain

Cyproheptadine - antihistamine that increases hunger

Divalproex sodium - Anticonvulsant

Gapapentig - Anticonvulsant, analgesic, used for neuropathic pain

Topiramate - anticonvulsant, decreases hunger....makes you skinny!

Propanolol - lowers BP

Verapamil - CCB