Migraine Headaches Flashcards
(99 cards)
1
Q
Cephalgia
A
head pain
2
Q
When a migraine headache gets activated, the ____ nerve is turned on
A
trigeminal
3
Q
Most common division of the trigeminal nerve effected that leads to migraines:
A
V1
4
Q
When the tirgeminal nerve gets acivated in a migraine, what nerve branches may be affected?
A
V1, V2, V3
5
Q
Migraine in which patient is feeling the pain in the mid face and may think it is a sinus issue or issue with the maxillary teeth is caused by branch:
A
V2
6
Q
Why should a general dentist care about headaches?
A
- The same nerve pathways (tirgeminal) is involved and may show up as a toothache, gingival pain, or facial pain in your patient
- Being able to diagnose referred pain from headaches will allow you to refer your patient to the proper specialist and AVOID UNECCESSARY DENTAL TX
7
Q
Headahces often arise in the morning so what do we think the patient may be doing in their sleep?
A
Bruxing or OSA
8
Q
Common causes of morning headaches due to oxygen desaturation:
A
OSA
9
Q
What are the two biggest reasons patients will awaken with morning headaches?
A
- Bruxim
- OSA
10
Q
T/F: It is rare that neuropathic pain will awaken the patient at night
A
True
11
Q
Professional organizations dedicated to the study of headaches:
A
- American headache society
- American migraine foundation
- International headache society
12
Q
Headaches can mimic _____
A
acute dental disease
13
Q
Headaches can mimic acute dental disease if:
A
located in lower half of face (V2-3)
14
Q
What types of headaches can mimic dental disease and cause tooth pain?
A
- migraine
- cluster headache
- paroxysmal hermicrania
15
Q
Acute dental pain may spread ____ but rarely ____
A
unilaterally; crosses the sideline of the face
16
Q
Clinical characteristics of dental pain:
A
- Intense throbbing
- Poorly lcoalized
- Generally provide by stimulation of the offending tooth (pressure, hot/cold)
17
Q
Second most common neurogoligcal disorder in the world:
A
Migraine
18
Q
Migraines effect more than ____ people worldwide
A
1 billion
19
Q
Migraines are 2-3 times more likely to be experienced by:
A
women
20
Q
Prevalence for migraines peaks at _______ years in both sexes
A
35-39
21
Q
Onset of migraines occurs in the _____ decades of life and then the frequency ____
A
First four decades; decreases
22
Q
Migraines will effect ____% of women over a lifetime
A
30%
23
Q
_____ million Americans are estimated to have severe migraine headaches
A
36 million
24
Q
The annual lost productivity in the U.S. due to migraine costs over ____ per year
A
1 billion
25
The criteria we use for headaches:
International classification of headaches disorders (3rd addition beta version)
26
Every time you are clenching, the ____ muscles are contracting
Temporalis and masseter
27
For a headache attributed to temporomandibular disorder (TMD), what criteria has to be met?
A) Any headache fulfilling criterion C
B) Clinical and/or imaging revealing evidence of TMD
C) Evidence of causation demonstrated by ateast 2 of the following criteria
1. headache has developed in temporal relation to onset of TMD
2. Either of both of
a) headache has significantly worsened in parallel with progression of TMD
b) headache has significantly improved or resolved in parallel with improvement in or resolution of TMD
3. Headache produced or exacerbated by active jaw movements, passive movements through range of motion of jaw and/or provocative maneuvers such as pressure on the TMJ and surrounding muscles of mastication
4. Headache, when unilateral, is ipsilateral to TMD
( must not be accounted for by another ICHD-3 diagnosis)
28
How might we treat someone with a headache attributed to a TMD:
Occlusal splint at night and then see if the headache improves as well
29
Primary headache disorders include:
1. migraine
2. tension-type headache
3. trigeminal- autonomic cephalgias (TAC's)
30
List the types of headaches that fall into the category of trigeminal-autonomic cephalgias (TACs)
3A: Cluster headache
3B: Paroxysmal hemicrania
3C: Hemicrania Continua
3D: SUNCT syndrome
31
When we say a headache is caused by a primary headache disorder, we are saying that:
The headache does not arise from as a secondary result of a primary cause (such as tumor that causes headache)
32
T/F: Headahces typically do not show up on MRIs
True
33
An episodic orofacial migraine diagnosis must wait until the patient has experienced:
at least 5 attacks
34
Describe the pain/location for episodic orofacial migraine:
Facial/oral pain, WITHOUT head pain, long lasting (4-72 hours)
35
For a headache to be diagnosed as episodic orofacial migraine, the pain has to have at least two of the following four characteristics including:
1. Unilateral location
2. Pulsating quality
3. Moderate or severe intensity
4. Aggravation by, or causing avoidance of routine
36
What branch of trigeminal nerve can cause a migraine that is either unilateral or bilateral?
V1
37
T/F: Migraine episodes only occur at nighttime
False- may occur at any time of the day or night
38
List the pain sensitive intracranial structures:
1. skin and blood vessels of the scalp
2. head and neck muscles
3. venous sinuses
4.arteries of the meninges
5. larger cerebral arteries
6. pain-carrying fibers of the 5th, 9th, and 10th cranial nerves
7. parts of the dura mater at the base of brain
39
The brain itself is ___ to pain
insensitive
40
At least 2/3 of our patients will have ____ either during or after their headache
Scalp tenderness
41
T/F: A genetic factor or familial history is present in most migraineurs
True
42
T/F: More than 50% of migraineurs have less than 2 attacks per month
True
43
44
What occurs once the serotonin (5-HT) receptor gets activated?
Potent vasoconstriction
45
What is one theory of why patients may experience nausea and vomiting during migraines?
Migraines and trigeminal autonomic cephalgias activated the trigeminoal vascular system, causing release of neuropeptides.
These neuropeptide activate the serotonin receptor (5-HT) which is found in the CNS, brain, platelets, and intestine. Vasoconstriction occurs in all of these sites
46
Migraines and trigeminal autonomic cephalgias cause activation of the:
trigeminovascular system
47
When the trigeminovascular system is activated, this leads to the release of inflammatory chemical mediators known as:
neuopeptides
48
What happens when neuropeptides are released in the brain?
Serotonin Receptor (5-HT) gets activated
49
What happens when the serotonin receptor (5-HT) is activated?
Serotonin acts as a neurotransmitter in the CNS & is a potent vasoconstrictor
50
What are some potential sites of the serotonin receptor?
1. brain
2. platelets
3. intesine
51
CGRP:
Calcitonin gene related peptide
52
Believed to play a major role in migraine pathogenesis:
Calcitonin gene related peptide (CGRP)
53
Newest migraine research and drugs are targeting the:
Calcitonin Gene Related Peptide (as this is though to play a major role in migraine pathogenesis)
54
What classifies a patient as having CHRONIC migraines?
More than 15 headaches per month
55
For chronic headaches, the FDA has approved:
Onobotulinum A
56
____% of migraine sufferers have a parent with the disorder and up to ___% have at least one first degree relative with migraines
50-60%; 80%
57
What chromosome is linked to migraines?
Chromosome 19
58
T/F: Cluster headaches rarely occur within the same family
True
59
____% of tension-type headache sufferers have family members with similar headaches
40%
60
Migraine is comorbid with:
1. stroke
2. epilepsy
3. depression
4. anxiety disoreders
61
In patients with migraine, anxiety disorders and major depression, the onset of _____ generally precedes _____.
anxiety precedes migraine
62
IN patient with migraine, anxiety disorders and major depression, the onset of anxiety generally precedes the onset of migraine, whereas the onset of _____ usually follows the onset of ____
Onset of major depression usually follows the onset of migraine
63
Migraine with aura:
classic migraine
64
Migraine without aura:
Common migraine
65
T/F: many patient have both common and classic migraines (in combo)
true
66
Less than 15 migraine days per month:
Episodic migraines
67
More than 15 migraines days per month:
Chronic migraines
68
Migraine attack phases include:
1. Prodrome
2. Aura
3. Headache
4. Headache resoluation
69
Phase of migraine attack occurring hours to days before the headache
Prodrome
70
Phase of migraine attack that immediately precedes or accompanies the headache
Aura
71
Headache resolution phase may take:
days
72
If a migraine sufferer gets an aura, the aura typically lasts
5-60 minutes
73
Prodrome phase of migraine is characterized by:
1. Changes in mood or behavior ( depression, hyperactive, euphoric, talkative, drowsy, restless, or irritable)
2. Neurological (sensitive to light and noise, difficulty concentrating, yawning, and hypersomnia)
3. General (stiff neck, food cravings, cold feeling, anorexia, sluggish and thirsty)
74
Occurs with approximately 30% of migraine attacks:
aura
75
Consists of gradually spreading neurological symptoms that usually preceded the headache by 5-60 min
aura
76
The most common aura symptoms are:
visual disturbances such as flashing lights (scotoma) or a zigzag pattern (fortication spectra)
77
The second most common type of aura:
parasthesias
78
What is the main concern with sensory aura such as paresthesia?
Mimics stroke symptoms
79
Additional (but less common) sensory aura symptoms:
1. motor symptoms (weakness or atonic)
2. Hyperkinetic movement disorders (chorea)
3. speech abnormalities (aphasia- absence of language or dysarthria- poorly articulated speech)
80
The location of the headache may be ____ or ____
bilateral; start on one side and become generalized
81
The average headache pain is on a ____ on a scale of 1-10
5
82
With headaches, ____ is common although food cravings may occur
anorexia
83
Nausea occurs in ____ % of headaches, while vomiting occurs in ____%
90%; 33%
84
What may cause a patient to seek a dark, quiet room?
Photophobia/ Phonophobia
85
T/F: Excerise will typically worsen a migraine
true
86
Systemic symptoms of headaches:
1. blurry vision
2. nasal stuffiness
3. anorexia
4. hunger
5. diarrhea
6. abdominal cramps
7. polyuria
8. pallor
9. sensations of hot & cold
10. sweating
11. scalp tenderness
87
What are the affective alterations of headaches (how the headache Affects the person)
1. impaired concentration
2. impaired memory
3. depression
4. fatigue
5. anxiety
6. nervousness
7. irritability
88
During the headache phase we see: (2)
1. systemic symptoms
2. affective alterations
89
Phase in which:
- pain diminishes
- fatigue, irritability, listlessness, impairment of concentration, or mood change may occur
- some migraine sufferers report euphoria during this phase
- some migraine sufferers report depression & tiredness
Resolution phase
90
Foods that can trigger migraines:
1. chocolate (contain bromide)
2. caffeine
3. cheeses (aged cheddar)
4. alcohol (esp. red wine)
5. foods containing monosodium glutamate (MSG), nitrates and aspirate
6. citrus fruites
91
Non-pharmacological therapies for headaches include:
1. biofeedback
2. psychotherapy
3. acupuncture
4. chiropracter
92
Produced by excessive use of NSAIDs, barbiturates, triptans, narcotics, and ergots :
Withdrawal or rebound headache
93
How can we minimize the risk of withdrawal or rebound headaches?
Limit usage of causative drugs to 3 days per week
94
List the order of steps in migraine management:
1. Psychotherapy (Pt education, stress reduction, and trigger avoidance)
2. Non-pharmacological methods
3. Pharmacologic methods
95
Neurstimulators stimulate both:
occipital and trigeminal nerce
96
What type of headaches are neurostimulators effective on?
Migraines and cluster headaches
97
a neurostimulator device that is a cuff worn on the upper arm that delivers electric pulses to nerves aiming to trigger a natural pain response in the brain to help treat migraine pain both acutely an dpreventatively
Nervio
98
Nerivio uses _____ to stimulate nerves in the upper arm that carry pain signals to the brain
remote electrica neuromodulation
99
Device that is the migraine treatment with external neurostimulation:
Transcutaneous Supraorbital Neurostiulator (Cefaly Device)
