Pain Associated with the Head

Question 1

Describe the process of a migraine

Answer 1

When trigeminal system activated
Peptides are released
Promoting inflammation reaction
= increases flow of sensory traffic through the brain stem

Question 2

What is the trigeminal nerve?

Answer 2

5th cranial nerve

Question 3

What are the 6 causes of headaches?

Answer 3

Traction/dilation of intra/extracranial arteries
Traction of large extracranial veins
Compression, traction or inflammation of cranial + spinal nerves
Spasm + trauma to cranial + cervical muscles
Meningeal irritation + raised intracranial pressure
Disturbance of intracerebral serotonergic projections

Question 4

Describe role of serotonin

Answer 4

Neurotransmitter
Mediator of migraines

Question 5

What are the 4 types of headaches?

Answer 5

Sinus
Cluster
Tension
Migraine

Question 6

What is a sinus headache?

Answer 6

Pain is usually behind the forehead + cheekbones

Question 7

What is a cluster headache?

Answer 7

Pain is in + around one eye

Question 8

What is a tension headache?

Answer 8

Pain is like a band squeezing the head

Question 8

What is a migraine?

Answer 8

Pain, nausea + visual changes are classic form

Question 9

What is the frequency for a tension headache?

Answer 9

Chronic
Often daily

Question 10

What is the duration of a tension headache?

Answer 10

30mins-7 days

Question 11

Where are tension headaches located?

Answer 11

Both sides
Whole head + neck

Question 12

What is the pain of a tension headache?

Answer 12

Mild-moderate
Pressure
Tightness

Question 13

What symptoms will not be present with tension headache?

Answer 13

Nausea + vomiting
Photophobia
Phonophobia

Question 14

What is the frequency for a migraine?

Answer 14

1-2/year
2-3/week

Question 15

What is the pain of a migraine?

Answer 15

Moderate-severe
Pulsating
Throbbing

Question 16

What is the duration of a migraine?

Answer 16

4hrs-3days

Question 17

What is the location of a migraine?

Answer 17

Usually one sided
(BUT can swap between attacks)

Question 18

What are the symptoms of migraines?

Answer 18

Aura
Nausea, vomiting
Sensitive to light, sound + smell

Question 19

How many stages is there of a migraine?

Answer 19

4
Prodrome
Aura
Headache
Postdrome

Question 20

What happens in Prodrome (stage 1)?

Answer 20

Days before actual pain
Light + sound sensitivity, depression, irritability + lack of appetite

Question 21

What happens in Aura (stage 2)?

Answer 21

One hour prior
Changes in visual perception
Seeing flashing lights + geometric patterns
Temporary loss of half of visual range

Question 22

What happens in Headache (stage 3)?

Answer 22

Moderate-severe pain
Up to 3 days
Also intolerance to light + noise, nausea + vomiting, sensitivity to movement + speech difficulties

Question 23

What happens in Postdrome (stage 4)?

Answer 23

Last for several days after
Irritable + fatigued
Scalp tender

Question 24

What can be some migraine triggers?

Answer 24

Foods - spices, wine Food additives Sleep Stress Female hormones Family history Medication Noise, light

Question 25

What is the main difference between a tension headache + migraine?

Answer 25

Aura Vomiting Aggravated by activity

Question 26

What type of symptoms can be experienced in the migraine Aura?

Answer 26

Positive neurological - additional - eg. visual flashes Negative neurological - loss - eg. blind spots, numbness

Question 27

What is the pain of cluster headaches?

Answer 27

Excruciating Penetrating, boring, non-throbbing

Question 28

What is the duration of cluster headaches?

Answer 28

15mins-3hrs Same time each day

Question 29

What is the location of cluster headaches?

Answer 29

Always the same side

Question 30

What are the symptoms of cluster headaches?

Answer 30

Watering eyes Nasal stuffiness, runny nose Red eye, swollen eyelids Sweating

Question 31

What is trigeminal neuralgia?

Answer 31

Intense, sharp, burning pain On one or both sides of face

Question 32

Where is trigeminal neuralgia normally distributed?

Answer 32

Along one or more of somatic sensory branches

Question 33

What are the causes of trigeminal neuralgia?

Answer 33

Pressure from blood vessel Demyelination of nerve Pressure from tumour Pressure damage to nerve

Question 34

What are the branches of the trigeminal nerve?

Answer 34

Ophthalmic nerve (CN V1) Maxillary nerve (CN V2) Mandibular nerve (CN V3)

Question 35

What is the mechanism of action of triptans?

Answer 35

Serotonin 5HT 1B/1D receptor agonists

Question 36

Describe triptans anti-migraine action

Answer 36

1. vasoconstriction 2. trigeminal inhibition 3. decreased pain transmission

Question 37

What are the mechanisms included in the triptans for migraines?

Answer 37

Intracranial vasoconstriction Inhibition of neurotransmission in trigeminocervical complex Inhibition of release of pro-inflammatory + vasoactive mediators