Lecture 67-69: Headaches Flashcards Preview

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Flashcards in Lecture 67-69: Headaches Deck (63):
1

Two kinds of migraine

With and without aura

2

Migraine without aura criteria

5 attacks at least 4 - 72 hours

3

Migraine with aura criteria

Migraine w/out aura symptoms + aura (visual, sensory, dysphasic...)

4

Migraine w/ aura symptom progression

Prodrome (cold hands/feet, odd feeling, food craving) --> aura --> headache

5

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"

6

Describe meningeal involvement in migraine

Meninges innervated by V1; activation causes neural-related inflammation in meninges, which may be related to incredible pain

7

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.

8

Pathway of head pain

1. Cortical spreading depression; 2. Inflammatory release in blood vessels of meninges; 3. Pain information travels through trigeminal nerve into brainstem nuclei

9

Describe the numbness pattern of migraine and the formal name

Cheiro oral numbness: face/hand numbness

10

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

11

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

12

Vascular issues with migraine might not be due to blood flow, but due to...

Intercellular communication with astrocytes

13

Most common headache? Describe

Tension headache; pressing, bilateral, steady mild-moderate pain, not aggravated by activity

14

What does a tension headache not have?

Nausea, photophobia, phonophobia

15

ANS migraine involvement

TNC can irritate superior salvitory nucleus --> ANS symptoms (sinus symptoms)

16

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

17

Four associations with migraines being bad...

1. 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)

18

Two neurological changes associated with migraine

1. Iron deposition in PAG; 2. White matter changes on MRI

19

3 Primary head aches

F

20

Red flags (6)

New/different headache; abrupt onset; cancer/HIV/preg; abnormal physical; neuro symptoms; headache onset with syncope/exertion

21

Comfort signs (5)

Stable; family/personal hx; normal physical; triggers; variable locations

22

Is it common for brain tumors to present with just headaches?

No: N/V, abnormal neurological exam, etc...

23

Idiopathic intracranial hypertension common in...What's happening? Presents like...

Obese women w/ menstrual abnormalities; brain swelling; brain tumor w/out local symptoms

24

Idiopathic increased intracranial pressure most commonly effects which nerve? What is this like?

VI nerve; causes VI nerve palsy = double vision in distance

25

Describe headaches with idiopathic intracranial hypertension

"Brain tumor headache," visual complaints (double vision), cranial bruits, N/V, radiculopathies

26

What does increased idiopathic intracranial pressure look like in a lab? (MRI and spinal tap)

Flattened post globes and normal CSF w/ increased pressure

27

Treatment...watch for?

Correct predisposing factors, diuretics, shunt; watch eyes (blindness can occur)

28

Headache and stroke: which circulation most frequently presents with headache?

Most frequent in posterior circulation

29

Is headache severity related to stroke severity (infarct size)?

No

30

% headache w/ intra parenchymal hematoma

50%

31

Sudden onset sever headache, think...

Aneurysm (subarachnoid)

32

How to diagnose SAH and how to diagnose aneurysm...

CT scan; catheter angiography

33

Cluster headaches

Intense, boring, unilateral pain with ANS effects (Horner's syndrome; eye watering); male predominance

34

Cluster headaches can be either...(2)

Episodic (bouts of headaches lasting 1-4 months w/ circadian patterns); chronic (no circadian patterns)

35

T/F: Cluster headaches can wake people out of sleep?

True

36

What is Giant Cell Artertis? Describe headache and location. Lab tests and what can it lead to?

Inflammation of arterial lining; generalized, throbbing, temporal; sedimentation rate; blindness due to ischemic optic neuropathy (stroke)

37

Did ya know, angina pain can refer to...

The head!

38

Describe headaches associated with sexual activity

Come on with orgasm, explosive onset

39

Describe headaches associated with carotid artery dissection

Headache w/ neck pain, facial pain, Horner's syndrome

40

Meningeal enhancement is typical with a...What else is associated with these?

Low pressure headache; positional (worse upon standing)

41

What procedure can bring about a LP-headache? Treatment?

An LP! caffeine, epidural blood patch if it persists

42

Describe trigeminal neuralgia headaches. Which V roots are typically affected?

Brief paroxysms of electric-like, intense pains; V2 and V3

43

Trigeminal neuralgia headaches caused (by age, treatment option for one)?

In young: MS; in old: looping SCA abutting trigeminal nerve

44

Treatment for SCA abutting trigeminal nerve?

Surgery: microvascular decompression

45

If you have >6 migraines/month, what kind of therapies (2)?

Preventative and acute

46

What is pulsating in migraines?

Spinal fluid

47

How is inflammation generated in migraine?

Release of neurochemicals from the nerve terminals leads to vasodilation and inflammation of vessels in meninges

48

T/F: Central sensitization plays a role in migraine.

True! TNC sensitization

49

Are opioids good for treating headache? Why (4)?

No. Pro-inflammatory, increases N/V, increases CSD via glutamate, sedating

50

What responds to triptans? Importance?

Headaches; does not diagnose type of headache

51

NSAID advantages for headache (4)

Does not induce headache, safe if you have vascular disease, non-sedating, no increase in nausea

52

What are prodromal symptoms due to? What drug class can be used to treat migraines? Advantages/disadvantages

DA activation; neuroleptics (D2 receptor blockers); effective, reduce N/V; cause sedation, prolonged QT, orthostatic hypotension

53

Dihydroergotamine: derived from and concerns

Ergot; vascular disease

54

What larger 5-HT families are were interested in migraine? Mechanism. What drug family?

5-HT1s (B: targets blood vessels and D: neural inhibition); agonists --> stimulating decreases neurogenic inflammation; triptans

55

Describe triptans

Reduce all aspects of migraine disability, minimal/no sedation, does not increase nauseau

56

Triptans we need to know (2)

Sumatriptan, eletriptan

57

Describe "triptan effect" and contraindications

Chest/back of the neck pressure; heart disease/HT

58

Serotonin syndrome (def and triad) and triptan

Life threatening condition associated with increased serotonin in CNS; mental status changes, autonomic hyperactivity, neuromuscular abnormalities; triptan + SSRIs might increase risk of serotonin syndrome

59

Theory of treating acute migraine

Treat early!

60

Model: drugs that are useful in the prophylaxis of migraine suppress...what's a lab test demonstrating this?

Cortical spreading depression; plasma glutamate increased with migraine and reduced with prophylaxis

61

Some SEs for migraine prophylactic drugs?

Weight gain, memory loss, depression, tremor

62

Classes and examples for prophylactic migraine treatment (4)

Beta-blockers (propranolol), tricyclic antidepressants (amitriptyline), antiepileptic (valproate, topiramate), anticholinergic (botox)

63

What is the one drug approved for chronic migraine?

Botox

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