Headaches (Week 2--Charles) Flashcards Preview

Block 5: Neuroscience > Headaches (Week 2--Charles) > Flashcards

Flashcards in Headaches (Week 2--Charles) Deck (18):
1


Primary vs. secondary headache


Primary: intrinsic to brain without any underlying structural, infectious, toxic/metabolic cause (migraine, tension headache, cluster headache)

Secondary: identifiable underlying cause (tumor, hemorrhage, meningitis)

2


Reasons to consider neuroimaging for headache


Abnormal unexplained neurological exam

Onset of headache over age 55

Associated fever

Headache with extremely abrupt onset

Headache refractory to aggressive treatment

First or "worst" headache ever experienced

Increasing frequency and/or severity of headaches

Change in headache clinical features

Headaches that don't "fit" primary headache criteria

3


Studies for investigating primary headaches


Space occupying lesions: brain scan, preferably MRI with contrast

Hemorrhage: brain scan, consider lumbar puncture with negative scan

Increased intracranial pressure: brain scan, lumbar puncture if scan is negative

Toxic/metabolic, inflammatory: lab studies

4


Does cutting brain parenchyma cause pain?


No!

That's why you can do awake neurosurgery

5


Is it blood vessels (vasodilation/constriction) that cause migraine symptoms?


No!

Dilation of blood vessels is neither necessary nor sufficient for causing migraine pain

Migraine is primarily a disorder of brain excitability

Vasodilation may occur as part of disorder but is not required for migraine pain

6


What can cause headache?


Lesions or electrodes in the periaqueductal grey region in the brainstem

Head pain can be evoked by stimulation of insular cortex

7

LIfetime cumulative incidence of migraine


43% of women have had a migraine, and 18% of men

8


Approach to treatment of headache patient


Diagnose patient and reassure them that they do not have a brain tumor

Identify and change exacerbating environmental factors, medications

Establish regimen for acute therapy of headache

Determine if preventive therapy is appropriate

9


ICHD criteria for migraine w/o aura


At least 5 attacks fulfilling the following:

Headaches lasting 4-72 hours

During headache at least one of: nausea and/or vomiting, photophobia and phonophobia

At least 2 of: unilateral location, pulsating quality, moderate or severe intensity, aggravated by physical activity

10


ID migraine validated screener


Has a headache limited your activities for a day or more in the last 3 months?

Are you nauseated or sick to your stomach when you have a headache?

Does light bother you when you have a headache?

11


Migraines can be mis-diagnosed as being what?


Sinus headache

TMJ

Tension headache/cervicogenic headache

12


Common headache triggers


Irregular meals

Irregular caffeine, chocolate, nuts, bananas

Irregular sleep (particularly excessive sleep)

Stress or "let-down" from stress

Any combination of the above

13


Medications that may make migraines worse


Oral contraceptives

Hormone replacement

SSRI antidepressants

Steroids (tapering)

Decongestants

Benzodiadepines (maybe?)

Bone density medications (maybe?)

14


Acute therapy for migraine


Triptans: selective serotonin 1B/1D agonists (sumatriptan, rizatriptan, etc)

DHE nasal spray

15


Migraine prophylaxis drugs


Beta blockers

Tricyclics

Ca2+ channel blockers

Serotonin uptake inhibitors

MAO inhibitors

NSAIDs

Methylsergide

New: valproic acid, divalproez sodium, memantine?, topiramate, BoTox

16


Cluster headache


Predominantly in men

"Eye pain"

Clusters of episodes with long periods of remission

Unilateral tearing/nasal discharge (autonomic phenomena)

Typically has circadian pattern, often same time each night

Therapy: short course of steroids taken early in cluster, verapamil for prevention, triptans (frovatriptan)

17


Tension headache


Often daily

Continuous, not in discrete episodes

Not disabling in severity

Typically worsens as day proceeds

Usually bilateral, constant

Doesn't respond to triptans

18


How do you treat exertional headache?


Indomethacin

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