Headaches and Migraine Flashcards
Primary care consultations (similar for specialists) for headache:
__% are primary
__% are secondary
__% medication over-use headaches.
80
12
6
How does the classification of primary and secondary headaches differ?
Primary - diagnosis made in the absence of physical signs
Secondary - diagnosis made in the presence of physical signs
Which type of primary headache is most common?
Tension-type
Migraine
Cluster headache
Tension-type headache (80%)
What defines a ‘normal’/tension-type headache?
Disappear soon after the noxious or potentially noxious stimulus has ceased
Describe a tension-type headache.
Band-like, bilateral Tightness/pressure/dull ache Radiate to neck and shoulders Mild to moderate Not aggravated by movement 30 min to several day
Describe a cluster headache. How are they treated?
Are they more common in men or in women?
Excruciating pain - they go on for 6-8 weeks, with about 6-8 attacks a day lasting 30 minutes to 3 hours.
Treat with 100% oxygen at 12-15L per minute, vasoconstrictors and triptans.
They are more common in men.
What are the criteria for migraine diagnosis?
A. At least five attacks in a lifetime fulfilling criteria B-D
B. Headache attacks lasting 4-72 hours
C. Headache has at least two of the following four characteristics:
1. Unilateral location
2. Pulsating quality
3. Moderate or severe pain intensity
4. Aggravation by or causing avoidance of routine physical activity
D. During headache, occurrence of at least one of following symptoms:
1. Nausea and/or vomiting
2. Photophobia and phonophobia
What are the five stages of a migraine?
Premonitory Aura Headache Resolution Recovery
How many % of migraine attacks are without aura?
70-80%
How can the pathophysiology of migraines be summarised in simple words? What about more scientifically?
Migraines are caused by triggers acting on an excitable brain, provoking a change in brain chemistry.
Triggers acting on an excitable brain cause:
Trigeminal vascular sensitization –> headache AND
–> vasodilation and central sensitisation (which –> headache)
They also cause:
Cortical spreading depression –> aura –> TGVS
What is an aura? Describe it.
Where does it emanate from?
Visual (99%) and/or sensory and/or speech/language symptoms.
It develops gradually, with symptoms lasting 20-30 minutes each, and typically resolved before the onset of the headache.
Visual cortex (NOT THE EYES)
Describe the five stages of migraine - how long do they each last? What are the symptoms?
- Premonitory – 12-48 hours, food craving, tired, heightened perception, fluid retention
- Aura – less than an hour
- Headache – 4-72 hours, nausea, vomiting, lethargy, sensitivity to light/sound/smell, difficulty focusing, poor concentration
- Resolution – 2-12 hours, vomiting, deep sleep, medication
- Recovery – 2-24 hours, feel tired, hungover, limited food tolerance, diuresis. The brain has to reset itself - can’t have a migraine daily.
What does having an aura increase your risk of?
Ischaemic stroke
Cortical spreading depression causes an aura. What does this mean?
A transient and local suppression of the spontaneous electrical activity in the cortex which slowly moves across the brain.
Explain the headache section of the migraine.
- Blood vessels in meninges become swollen/stretched and release neuro-inflammatory peptides.
- This activates the nerves, which send a pain signal to the trigeminal ganglion. This is responsible for peripheral sensitisation (throbbing pain).
- The trigeminal ganglion transmits to nucleus caudalis, which provokes central sensitisation (this prolongs/continues the attack = ALLODYNIA). This happens within 60 minutes of the onset of pain and can last up to 10 hours.
- Pain impulses are then relayed to the thalamus.
- Relayed from thalamus to cerebral cortex, where the impulses are decoded as pain.
