Migraine and Headache

Question 1

primary headache

Answer 1

headache with no clinical signs

Question 2

secondary headache

Answer 2

headache with clinical signs

Question 3

what signs may be present in a secondary headache

Answer 3

tumour
fits
temperature
rash
stiff neck

Question 4

3 main types of primary headaches

Answer 4

migraine
cluster
tension

Question 5

what causes a tension headache

Answer 5

brain response to factor adversely affecting function

Question 6

how does a tension headache feel

Answer 6

bilateral band like tightness/pressure/dull ache
can radiate to neck and shoulders

Question 7

are tension headaches aggravated by movement

Answer 7

no

Question 8

are tension headaches relieved by painkillers

Answer 8

yes

Question 9

how long do tension headaches last

Answer 9

30 mins-several days

Question 10

why does medication overuse cause headaches

Answer 10

suppression of endogenous pain response cause headaches when painkillers stopped

Question 11

what is the most painful headache type

Answer 11

cluster

Question 12

what triggers a cluster headache

Answer 12

blood vessel dilation - eg due to alcohol

Question 13

how long do cluster headaches last

Answer 13

usually less than 3 hrs
often in seasonal attacks of 6-8 weeks

Question 14

cluster headache treatment

Answer 14

high dose oxygen via non rebreather mask
tryptans

Question 15

cluster headache prophylaxis

Answer 15

verapamil

Question 16

how long do migraines last

Answer 16

4-72 hrs

Question 17

characteristics of migraines

Answer 17

unilateral
pulsating
moderate-severe
photophobia
phonophobia
nausea
vomiting

Question 18

are migraines aggravated by physical activity

Answer 18

yes

Question 19

phonophobia

Answer 19

fear of sound

Question 20

difference between episodic and chronic migraines

Answer 20

episodic - <15 days/month
chronic - >15 days/month for 3+ months

Question 21

what brain abnormality leads to migraines

Answer 21

hypervigilant brain unable to filter out unnecessary stimuli

Question 22

what can trigger a migraine

Answer 22

hormones
lack of food
dehydration
lack of sleep

Question 23

what are the 2 types of migraine

Answer 23

with aura
without aura

Question 24

does 5HT trigger or relieve migraines

Answer 24

relieve

Question 25

5 stages of a migraine

Answer 25

premonitory aura headache resolution recovery

Question 26

aura

Answer 26

visual/sensory/speech/language symtoms

Question 27

when and how long does aura occur

Answer 27

20mins-1 hr usually resolves before headache

Question 28

how does visual aura appear

Answer 28

zigzag lines spreading across field of vision

Question 29

what causes aura

Answer 29

cortical spreading depression

Question 30

cortical spreading depression

Answer 30

transient and local suppression of spontaneous activity in the cortex moving slowly across the brain

Question 31

activation of which system is implicated in migraine

Answer 31

trigeminovascular system

Question 32

does CGRP level increase or decrease during migraine attacks

Answer 32

increase

Question 33

how are CGRP levels effected by triptans

Answer 33

decreased

Question 34

2 parts of migraine pathophysiology

Answer 34

peripheral sensitisation - trigeminal ganglion sensitised central sensitization - dorsal horn sensitised

Question 35

migraine pathophysiology

Answer 35

neuropeptides activate nerve pathways -> pain signals to trigeminal ganglion -> trigeminal nerve transmits pain to SpV in brainstem -> pain relayed to thalamus and onto cortex

Question 36

how can a migraine be stopped

Answer 36

cannot be stopped once started

Question 37

migraine treatment

Answer 37

5HT agonists Gepants CGRP monoclonal antibodies

Question 38

what type of drug are triptans

Answer 38

5HT agonist

Question 39

triptan examples

Answer 39

sumatriptan zolmitriptan naratriptan almotriptan frovatriptan

Question 40

triptan action

Answer 40

vasocontriction

Question 41

what are Gepants

Answer 41

small molecule CGRP receptor antagonists

Question 42

Gepant examples

Answer 42

rimegepant ubrogepant

Question 43

are gepants taken acutely or preventatively

Answer 43

acutely preventative in clinical trials

Question 44

are CGRP monoclonal antibodies used acutely or preventatively and how are they administered

Answer 44

preventatively monthly SC injection

Question 45

how do CGRP monoclonal antibodies work

Answer 45

bind to CGRP or CGRP receptor to prevent vasodilation

Question 46

CGRP monoclonal antibody examples

Answer 46

erenumab eptinezumab fremanezumab galcanezumab