Lecture 67-69: Headaches Flashcards
Two kinds of migraine
With and without aura
Migraine without aura criteria
5 attacks at least 4 - 72 hours
Migraine with aura criteria
Migraine w/out aura symptoms + aura (visual, sensory, dysphasic…)
Migraine w/ aura symptom progression
Prodrome (cold hands/feet, odd feeling, food craving) –> aura –> headache
Cortical spreading depression theory of migraine; related to what brain state?
Wave of neuronal depolarization followed by a suppression of neuronal activity with corresponding blood flow changes moved across cerebral cortex at about 3 mm/minute; “hyperexcitable brain”
Describe meningeal involvement in migraine
Meninges innervated by V1; activation causes neural-related inflammation in meninges, which may be related to incredible pain
What brainstem centers are activated in migraine? Describe.
PAG and TNC (trigeminal nucleus caudalis); PAG connecs to the TNC and is known to exert inhibitory influences on that structure. This region of the midbrain is activated during a migraine attack and this activity persists even after the pain has been relieved.
Pathway of head pain
- Cortical spreading depression; 2. Inflammatory release in blood vessels of meninges; 3. Pain information travels through trigeminal nerve into brainstem nuclei
Describe the numbness pattern of migraine and the formal name
Cheiro oral numbness: face/hand numbness
Glial cells and migraine. Why and relation to vulnerable cortex?
Glial cells may propagate cortical depression wave; glial cells redistribute ions, etc and primary occipital cortex has lowest glial-neronal ratio, so if there is an ion imbalance, this region would be extra vulnerable
Describe astrocyte waves in more detail (ion, and what is released)
Astrocyte calcium waves could mediate propagated cortical phenomena of migraine via release of neuroactive and vasoactive messengers
Vascular issues with migraine might not be due to blood flow, but due to…
Intercellular communication with astrocytes
Most common headache? Describe
Tension headache; pressing, bilateral, steady mild-moderate pain, not aggravated by activity
What does a tension headache not have?
Nausea, photophobia, phonophobia
ANS migraine involvement
TNC can irritate superior salvitory nucleus –> ANS symptoms (sinus symptoms)
Childhood migraine: 7 unique symptoms
Benign paroxysmal vertigo, alternating hemiplegia, cyclic vomiting, recurring ab pain, benign torticollis (head turns to one direction), confusion, car sickness
Four associations with migraines being bad…
- Progression (get worse over time, so you should TREAT early); 2. Migrainous stroke (risk factor for stroke, especially for women); 3. Persistant aura without infarction (aura that never goes away); 4. Epilepsy (more miraines, increased risk for epilepsy)
Two neurological changes associated with migraine
- Iron deposition in PAG; 2. White matter changes on MRI
3 Primary head aches
F
Red flags (6)
New/different headache; abrupt onset; cancer/HIV/preg; abnormal physical; neuro symptoms; headache onset with syncope/exertion
Comfort signs (5)
Stable; family/personal hx; normal physical; triggers; variable locations
Is it common for brain tumors to present with just headaches?
No: N/V, abnormal neurological exam, etc…
Idiopathic intracranial hypertension common in…What’s happening? Presents like…
Obese women w/ menstrual abnormalities; brain swelling; brain tumor w/out local symptoms
Idiopathic increased intracranial pressure most commonly effects which nerve? What is this like?
VI nerve; causes VI nerve palsy = double vision in distance
