Term
| What is the incidence of migraines? |
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Definition
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Term
| What is the prevalence of migraines? |
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Definition
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Term
| What is the age group most affected by migraines? |
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Definition
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Term
| What is a primary headache? |
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Definition
| pain that is localized to the head that is not associated with underlying disease |
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Term
| What is a secondary headache? |
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Definition
| pain localized to the head that results from an identifiable trigger, known pathophysiology, or conforms to a known pain syndrome |
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Term
| Name some different examples of primary headache. |
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Definition
| migraine, tension, cluster, idiopathic stabbing, exertional, paroxysmal hemicrania |
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Term
| What are the typical symptoms of migraine headache? |
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Definition
| often unilateral and throbbing in quality, intensity often severe (10/10) with decreased activity, may be accompanied by nausea, vomiting, photophobia or phonophobia |
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Term
| What type of headache characteristically has a strong family history |
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Definition
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Term
| What are the typical characteristics of tension-type headaches? |
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Definition
| frequently bilateral with pressure (band-like) quality; intensity may be severe (10/10) with decreased activity, maybe accompanied by nausea, vomiting, photophobia or phonophobia |
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Term
| What type of headache typically has an afternoon onset? |
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Definition
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Term
| What are the two subcategories of tension headache? |
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Definition
| episodic tension-type headache and chronic tension-type headache |
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Term
| What are the characteristics of episodic tension-type headache? |
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Definition
| 90% experience mild-moderate pain, 3-4x per month |
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Term
| What are the characteristics of chronic tension-type headache? |
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Definition
| 86% moderate-severe pain, more than 15x/month |
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Term
| What are the symptoms of chronic tension-type headache? |
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Definition
| can be bilateral, throbbing, exacerbated with movement, photophobia or phonophobia frequent |
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Term
| What is the typical patient population of episodic tension-type headache? |
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Definition
| more prevalent in highly educated population |
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Term
| What is the typical patient population of chronic tension-type headache? |
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Definition
| lower level of education, especially in women |
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Term
| T/F Muscle tension is correlated to the severeity of tension headaches. |
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Definition
| false; muscle activity is increased only in half of all headaches |
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Term
| What is the only headache more frequent in males? |
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Definition
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Term
| What are the symptoms of cluster headache? |
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Definition
| typically unilateral (stabbing quality stereotypical pattern), intensity severe (10/10) with INCREASED activity, frequent painful event of short duration with a characteristic pain-free interval; sudomotor changes |
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Term
| What are the sudomotor changes associated with cluster headache? |
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Definition
| injected sclera, erythema sweating on the side of the headache |
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Term
| What are the inervated structures in the cranial cavity? |
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Definition
| large cerebral vessels, pial vessels, large venous sinuses, basal area of the dura mater (contains mast cells) |
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Term
| What happens during the peripheral inflammatory response? |
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Definition
| release of substance P, CGRP, and increased blood flow as well as increased sensitivity |
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Term
| What happens as there is central sensitization to episodic tension-type headache? |
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Definition
| increase tenderness in cranial muscles (especially when frequency of headache is >25/month), but response to mechanical stimulation is normal |
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Term
| What happens as sensitization occurs with migraine headaches? |
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Definition
| expansion of headache, sensitivity to movement, reduced threshol to thermal and mechanical stimulation and enhanced cardiovascular response to skin stimulation; 79% experience thermal/mechanical allodynia |
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Term
| What happens when there is central sensitization to chronic tension type headaches? |
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Definition
| more sensitive to both thermal and mechanical stimulation |
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Term
| What areas are involved in central activation during migraine attack? |
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Definition
| rostral brain stem (midbrain/pons), cingulate and frontal cortex, visual and auditory association cortex, dorsal raphe nucleus, locus ceruleous (decreases blood flow through alpha-2 adrenergic mechanisms) |
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Term
| What are the treatment options for abortive therapy? |
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Definition
| NSAIDS, ergotamine, barbiturates, corticosteroids, phenothiazines, tripans, opiates |
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Term
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Definition
| sumatriptan/naproxen for abortive treatment of headaches |
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Term
| Sumatriptan/naproxen combo is contraindicated in patients who.. |
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Definition
| have ulcers, cardiovascular disease, or cerebrovascular disease |
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Term
| What is the MOA of sumaptriptan/naproxen? |
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Definition
| 5-HT 1B/1D agonist and COX inhibitor |
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Term
| What are the adverse effects of sumatriptan/naproxen combo? |
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Definition
| flushing, hypertension, vasospasm, chest pain or tightness |
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Term
| What are options for prophylactic treatment of headache? |
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Definition
| beta blockers, alpha agonists, calcium channel blockers, TCAs, anticonvulsants,5-HT2 antagonists, diuretics, botulinum toxin injection |
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Term
| Name some calcium channel blockers that can be used as prophylactic treatment of headache? |
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Definition
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Term
| Name some TCAs that can be used as prophylactic treatment for headaches? |
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Definition
| amitryptyline, nortriptyline, doxepin |
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Term
| Name some anticonvulsants that can be used to treat headache? |
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Definition
| valproic acid, topiramate, zonisamide |
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Term
| What is a serious adverse effect of using 5-HT2 antagonists to treat headaches? |
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Definition
| retroperitoneal/retropulmonary fibrosis |
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Term
| What diuretics are used to treat headache? |
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Definition
| catamenial pattern; acetazolamide |
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Term
| What are the prophylactic treatment options for cluster headache? |
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Definition
| ergotamine, methasergide, lithium, cyproheptadine |
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Term
| What is an abortive treatment option for cluster headache? |
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Definition
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Term
| What should patients with headache keep a record of? |
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Definition
| frequency and intensity of headaches, work absences, and amount of abortive medication required |
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