Migraine Headaches Flashcards
(100 cards)
1
Q
Cephalgia:
A
pain
2
Q
When a migraine headache gets activated, the ____ nerve is turned on
A
Trigeminal nerve
3
Q
most commom division of the trigeminal nerve effected that leads to migraines:
A
V1
4
Q
When the trigeminal nerve gets activated in a migraine, what nerve branches may be affected?
A
V1, V2 or V3
5
Q
Migraine in which patient feels pain in the midface and may think its a sinus issue or pain in maxillary teeth is caused by branch:
A
V2
6
Q
Why should a general denstist care about headaches?
A
- the same nerve pathway (trigeminal) is involved and may show up as a toothache, gingival pain or facial pain in your patient
- being able to diagnosed referred pain from headaches will allow you to refer your patient to the proper specialist and avoid unnecessary dental treatment
7
Q
Headaches 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 cause of headaches due to oxygen desaturation:
A
OSA
9
Q
What are the two biggest reasons patients will awaken with morning headaches?
A
- bruxism
- 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 headache:
A
- american headache society
- american migraine foundations
- international headache society
12
Q
Headaches can mimic _____
A
acute dental disease
13
Q
Headaches can mimic acute dental disease if located in the:
A
Lower half of the face (V2,-3)
14
Q
What types of headache can mimic dental disease and cause tooth pain?
A
- migraine
- cluster headache
- paroxysmal hemicrania
15
Q
Acute dental pain may spread ______ but rarely _____
A
unliateraly; crosses midline of the face
16
Q
Clinical characteristics of dental pain:
A
- intense throbbing
- poorly localized
- generally provoked by stimulation of the offending tooth (pressure, hot, cold)
17
Q
The second most common neurological disorder in the world:
A
Migraine
18
Q
Migraines affect more than ____ people worldwide
A
1 billion
19
Q
Migraines are 2-3 times more likely to be experienced by:
A
women
20
Q
Prevelance for migraines peaks at ages _____ in both sexes
A
35-39
21
Q
Onset of migraines occurs in the ____ decades of life and then the frequency ____
A
first four; declines
22
Q
Migraines will affect ____% 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 US due to migraine cost of ____ per year
A
$1 billion
25
The criteria we used for headaches is called the:
international classifcation of headache disorders (3rd edition beta version)
26
Every time you are clenching the ____ muscles are contracting
Temporalis & 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 reveals evidence of TMD
C) Eidence of causation demonstrated by at least two of the following criteria
1. Headache has developed in temporal relation to onset of TMD
2. Either or 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 movements such as pressure on the TMJ and surrounding muscles of mastication
4. headache, when unilateral, is ipsilateral to TMD
(must not be accounted for vy another ICHD-3 diagnosis)
28
How might you treat someone with a headache attributed to a TMD?
Occlusal splint orn at night & then watch for improvement of headache
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 cephaligias (TAC's)
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 as a secondary result from a primary cause
(such as tumor that causes headache)
32
T/F: headaches typically do not show up on MRI's true
True
33
An episodic orofacial migraine diagnosis must wait until the patient has experienced:
five attacks
34
Describe the pain/location for episodic orofacial migraine:
facial and/or 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:
1. unilateral location
2. pulsating quality
3. moderate or severe intensity
4. aggravation by, or causing avoidance of routine
36
What branch of trigeminal can cause a migraine that is either unilateral or bilateral?
V1 division
37
T/F: Migraine episodes only ocur at night time
False- may occur at any time of the day or night
38
List the pain sensitive intracranial structures:
1. skin & blood vessels of the scalp
2. head & 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 base of brain
39
The brain itself is ____ to pain
insensitive
40
Atleast 2/3 of our patients will have ______ either during or after the 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
Once neuropeptides are released in the brain, the _____ gets activated
Serotonin receptor (5HT)
44
What occurs once the Serotonin receptor (5HT) gets activated?
Potent vasoconstriction
45
What is one theory of why patients may experience nausea and/or vomiting during migraines?
Migraines & trigeminal autonomic cephalgias activate trigeminovascular system, which causes release of neuropeptides. These neuropeptides active the serotonin receptor 5-HT which is found in the CNS, brain, platelets and intestine. Vasocontstriction occurs in all of these sites
46
Migraines and trigeminal autonomic cephalgias cause activation of the:
Trigeminovascular system
47
When the trigeminovacular system is activated, this leads the release of inflammatory chemical mediators known as:
Neuropeptides
48
What happens when neuropeptides are released in the brain?
Serotonin receptor (5HT) gets activated
49
What happens when the serotonin receptor (5HT) gets activated?
Serotonin is released and acts as neurotransmitter in the CNS and is a potent vasoconstrictor
50
What are some potential sites of the serotonin receptor?
Brain, platelets, intestines
51
CGRP:
Calcitonin gene related peptide
52
Belived to play a major role in migraine pathogenesis:
Calcitonin gene related peptide (CGRP)
53
The newest migraine research and drugs are targeting the:
Calcitonin gene related peptide (CGRP)
(as this is thought to play a major role in migraine pathogenesis)
54
What classifies a patient as having a CHRONIC migraines?
more than 15 headaches per month
55
For chronic headaches, the FDA has approved:
Onabotulinum A
56
_____% of migraine sufferers have a parent with the disorder, and up to ____% have 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 a comorbid with:
1. stroke
2. epilepsy
3. depression
4. anxiety disorders
61
In patients with migraines, anxiety disorders & major depression, the onset of _____ generally precedes ____
anxiety precedes migraine
62
In patients with migraines, anxeity disorders & major depression, the onset of anxiety generally precedes 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 patients have both common & classic migraine (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 resolution
69
phase of migraine attack occuring 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 migraine sufferer gets an aura it 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, irritable)
2. Neurological (sensitive to light & noise, yawning, difficulty concentrating, hypersomnia)
3. General (stiff neck, food cravings, cold feeling, anorexia, sluggish & thirsty)
74
Occurs with approximately 30% of migraine attacks:
aura
75
Consists of gradually spreading neurological symptoms that usually precede the headache by 5-60 minutes:
Aura
76
The most common aura symptoms are:
Visual disturbances such as flashing lights (scotoma) or zigzag pattern (fortication spectra)
77
The second most common aura:
Parasthesias
78
What is main concern with sensory auras such as parasthesias?
Can mimic stroke symptoms
79
Additional but less common sensory aura symptoms:
1. motor symptoms (weakness or atonia)
2. hyperkinetic movement disorders (chorea)
3. speech abnormalities (aphasia- absence of language or dysarthria- poorly rticulated speech)
80
The locatio of the headache may be _____ or ______
bilateral; start on one side and become generalized
81
The average headache pain is 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% nausea
33% vomiting
84
What may cause a patient to seek a dark quiet room?
Photophobia/Phonophobia
85
T/F: Exercise 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 headache (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:
systemic symptoms & 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 during this phase
Resolution phase
90
Foods that can trigger migraines:
1. chocolate (contains bromide)
2. caffeine
3. cheeses (aged cheddar)
4. alcohol (especially red wine)
5. foods containing monosodium glutamate (MSG), nitrates & aspartate
6. citrus fruits
91
Non-pharamcological therapies for headaches include:
1. biofeedback
2. psychotherapy
3. acupuncture
4. chiropractic
92
Produced by excessive use of NSAIDs, barbituates, triptans, narcotics & ergots:
Withdrawal or rebound headache
93
How can we minimize the risk of withdrawal or rebound headaches?
Limit usage of causative drugs to 2 days/week
94
Order of steps in migraine management:
1. Psychotherapy (patient education, stress reduction & trigger avoidance)
2. Non-pharmacologic methods
3. Pharmacologic methods
95
Neurostimulators stimulate both:
Occiptal & trigeminal nerve
96
What type of headaches are neurostimulators effective on?
Migraine & 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 acutely and preventative:
Nervio
98
Nervio uses ______ to stimulate nerves in the upper arm that carry pain signals to the brain
remote electrical neuromodulation (REN)
99
Device that is a migraine treatment with external neurostimulation:
Transcutaneous supraorbital neurostimulator (Cefaly device)
100
