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Flashcards in Headaches! Deck (19)
1

What are Primary Headaches?

 

HA without intracranial Pathology (like tumors etc) 

 

 

2

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

3

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! 

4

Criteria for migraine without aura?

2 of the following:

- unilateral

- pulsating pain

- nausea

-photophobia/phonophobia

 

BOTH of the following: 

- similar pain in past

- no organic disease 

5

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 

 

*TRYPTANS CONTRAINDICATED IN COMPLICATED MIGRAINES

6

What is a tension-type HA?

Often bilateral

Squeezing pain - worse as day goes on 

Less severe than migraine

*NO AUTONOMIC SYMPTOMS

 

7

Causes of Secondary HA?

Tumor

HTN

Infection

Acute hemorrhage (like Sub-Arachnoid Hemorrhage) 

8

Pattern for secondary HA from Tumor

Chronic Progressive pain

worse in morning (ICP increased) 

Exacerbated by valsalva 

9

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

10

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

11

Other secondary causes of HA?

Sinusitis

TMJ

Primary Intracranial HTN

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

12

Red Flags for secondary HA?

SNOOP

Systemic symptoms - weight loss, stop mensturating

Neuro symptoms 

Onset - rapid or chronic

Older - (pts >40) 

Previous HA history is different 

13

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 

 

 

14

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

15

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 

16

STrategy for Medicine? 

STRATIFIED CARE

17

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) 

18

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 

19

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