Headaches and Migraine Flashcards Preview

Brain and Behaviour Year 2 > Headaches and Migraine > Flashcards

Flashcards in Headaches and Migraine Deck (44)
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1
Q

When is headache most likely to effect someone

A
  • in the reproductive years
2
Q

name the 3 questions which can predict If you have migraines or not

A
  • does Light bothers you
  • Your headaches limit your ability to work study or do what you need to do
  • Nausea or sick

Positive predictive value for migraine diagnosis

  • 2 positive answers 93%
  • 3 positive answers 98%
3
Q

how do you diagnose primary headaches

A
  • Diagnosis is made on the history in the absence of physical signs (all based on history as any tests or investigations are not relevant to the headache)
4
Q

How do you diagnose secondary headaches

A
  • Diagnosis is made on the history in the presence of physical signs (think that someone has a headache you do specific physical tests on them to work it out)
5
Q

What are the 3 main headaches

A
  • Diagnosis is made on the history in the absence of physical signs (all based on history as any tests or investigations are not relevant to the headache)
6
Q

Name some causes of headaches

A
  • Insufficient sleep
  • Mentral stress
  • Alcohol
  • Excess heat
  • Reading
  • Excess noise
  • Excess light
  • Excess sleep
  • Travel
  • Hunger
  • Shopping
7
Q

when do normal headaches disappear

A
  • Disappear soon after the noxious or potentially noxious stimulus has ceased
8
Q

describe the characteristics of a tension headache

A
  • Band-like, bilateral
  • Tightness/pressure/dull ache
  • Radiate to neck and shoulders
  • Mild to moderate
  • Not aggravated by movement
  • 30 minutes to several day
9
Q

what can cause a cluster headache

A
  • Within a cluster anything that can cause vasodilation such as alcohol, caffeine, smoking and exercise can trigger it
10
Q

How do you treat a cluster headache

A
  • Oxygen in high doses works as a vasoconstrictor so can be used, or sumatriptan can be used as an injection as a treatment for a cluster headache
  • these are both vasoconstrictors
11
Q

describe what a cluster headache is like

A
  • Occurs in clusters
  • Linked to circadian rhythm
  • Experience severe headaches
  • Start a few hours after they go to sleep with excruciating headache that effects one side of the head – centres on the eye, can get several attacks in one day
12
Q

How does the international headache society criteria define a migraine without aura

A

A. At least five attacks in a lifetime fulfilling criteria B-D

B. Headache attacks lasting 4-72 hours (untreated or unsuccessfully treated)

C. Headache has at least two of the following four characteristics:

  1. Unilateral location
  2. Pulsating quality
  3. Moderate or severe pain intensity
  4. Aggravation by or causing avoidance of routine physical activity (e.g. walking or climbing stairs)

D. During headache, occurrence of at least one of following symptoms:

  1. Nausea and/or vomiting
  2. Photophobia and phonophobia
13
Q

How common are the 3 main types of headaches

A
  • Tension type headache= 80% = female more likely
  • Migraine = 15% = female more likely
  • Cluster headache = 0.2-0.3 = male more likely
14
Q

what in genetics may cause a migraine

A
  • Over-responsive brains

- Heightened senses – smell, light, sounds, touch – doesn’t filter out stuff that is not important

15
Q

what can be used to treat headaches if genetics leading to heighten senses cause migraines

A
  • Help desensitise the brain – antiepileptic, some of the anti-hypertensives, Botox
16
Q

what are the triggers of a migraine

A
  • Triggers include lack of food, dehydration, lack of sleep, and an extra trigger of hormonal triggers – once these cross the threshold this sets of a change in brain chemistry – you cannot abort an attack even if you can alleviate symptoms
  • It is not what triggers it is how many triggers that you have had
17
Q

describe the migraine threshold

A
  • this is the idea that once you have had a certain number of triggers you can develop a migraine
  • people who’ve migraines a lot might have a lower threshold than other people
18
Q

what percentages of migraines are with aura and without aura

A

Migraine without aura – 70-80% of attacks

Migraine with aura – 20-30% attacks, 1% without headache

19
Q

When do you get the first signs of a migraine starting

A
  • 48 hours before they experience a headache there state of health declines, this mirrors that migraines are chemical areas, this is about 24-48 hours before the set of aura
  • At this particular time there is a release of serotonin from storage sites in the body
20
Q

is serotonin a vasodilator or a vasoconstrictor

A
  • Vasoconstrictor and/or vasodilator depends if the blood vessels is already constricted or dilated
21
Q

where is serotonin found

A
  • 90% in gut,
  • 8-10% in platelets
  • 1-2% in brain
22
Q

what is the link between serotonin and migraines

A
  • Increase urinary metabolites (5HIAA) in attacks
  • Drugs that deplete 5HT trigger migraine
  • 5HT infusions relieve migraine
  • Many drugs specific to migraine act on 5HT
23
Q

What are the 5 stages of migraine

A
  1. Premonitory
  2. Aura
  3. Headache
  4. Resolution
  5. Recovery
24
Q

describe the premonitory stage

A
  • Food craving
  • Yawing
  • Neck pain
  • Heightened perception
  • Fluid retention
25
Q

describer the aura stage

A
  • Lasts less than 1 hour

- Visual (99%) and or sensory and or speech/language symptoms

26
Q

describe the characteristics of the aura stage

A
  • Gradual development
  • Duration of each symptom typically lasts 20-30 minutes – less than 1 hour
  • Complete reversibility
  • Typically resolves before the onset of headache
  • No motor weakness
  • You don’t need eyes to see an aura – because it is the visual cortex at the back of the brain that creates what you see
27
Q

What triggers the aura stage

A

Thought that the aura is linked to cortical spreading depression
- A transient and local suppression (depression) of spontaneous electrical activity in the cortex(cortical) which moves slowly across the brain(spreading) which is thought to trigger the aura

28
Q

describe the headache stage

A
  • Anorexia/nausea/vomiting
  • Malaise/lethargy
  • Sensitive to light/sound
  • Heightened sense of smell
  • Difficulty focusing
  • Poor concentration
29
Q

describe the resolution stage

A
  • Vomiting
  • Deep sleep
  • Medication
30
Q

describe the recovery stage

A
  • Limited food tolerance
  • Tired
  • Hungover
  • Diuresis
31
Q

what organ is key in the premonitory stage of a headache

A

hypothalamus

32
Q

describe the trigeminovascular pathway

A
  • In the meninges in the dura there are neuropeptide induce which lead to vasodilation, this neuropeptide leads to dilated meningeal arteries which release inflammatory neuropeptides, the main one is CGRP ( it is released acutely in pain condition and acutely in a migraine attack)
  • Neuropeptides activate the nerve pathways
  • Nerve send pain signals to the Trigeminal ganglion
  • Peripheral sensitiation – sensitised peripheral neurone to the trigminal ganglion
  • Trigeminal nerve transmits pain impulses to SpV in the brainstem
  • Central sensitization – mediates allodynia
  • Pain impulses relayed to the thalamus
  • Information passes from the thalamus to cortex
  • Cortex decodes message perceived as pain
33
Q

What is allodynia

A

Allodynia refers to central pain sensitization (increased response of neurons) following normally non-painful, often repetitive, stimulation
- e..g when clothes touch you you would feel pain

34
Q

what is CGRP

A
  • Calcitonin gene-related peptide
35
Q

describe the structure of CGRP

A
  • 37 amino acid neuropeptide

- Widely distributed throughout the central and peripheral nervous systems

36
Q

What does CGRP do

A

potent vasodilator

37
Q

describe what happens to CGRP levels

A
  • CGRP levels increase during spontaneous migraine attakcs
  • CGRP levels decrease after effective symptomatic treatments with triptans
  • CGRP infusions trigger migraine
  • Many drugs specific to migraine act on CGRP
38
Q

name the two types of 5HT agonists used to treat migraines

A
  • Triptans e.g. sumatriptan (vasoconstrictors)

- Diatans e.g. -Lasmiditan – 5HT1F agonist – neutrally active antimigraine agent

39
Q

Why can you not give triptans to certain people

A

cant give to cardiovascular patients as it is a vasoconstrictor

40
Q

what are gepants

A

small molecule CGRP receptor anataognist

41
Q

What are monoclonal Abs

A

Large (mAbs) molecule CGRP antagonist

42
Q

What is the difference between Gepatns and monoclonal Abs

  • size
  • therapy type
  • half life
  • target specificity
  • clearance
  • administration
  • blood brain barrier
  • immunogenicity
A

Gepants

  • size = smaller
  • therapy type = acute/preventive
  • half life = minutes to hours
  • target specificity = lower specificity
  • clearance = liver and kidney
  • administration = oral
  • blood brain barrier = crosses
  • immunogenicity = no

monoclonal abs

  • size = larger
  • therapy type = preventative
  • half life = 3-7 weeks
  • target specificity = highly specific
  • clearance = reticuloendothelial system
  • administration = IV/SC
  • blood brain barrier = limited
  • immunogenicity = yes
43
Q

describe how drugs against CGRP work

A

Once CGRP is released, it can act on receptors located on blood vessels, on neurons and glia

The anti-CGRP receptor monoclonal antibody (mAb) erenumab also blocks the receptor

The other anti-CGRP mAbs bind to CGRP once it is released

Triptans can inhibit the release of CGRP

44
Q

What does erenumab do

A

The anti-CGRP receptor monoclonal antibody (mAb) erenumab also blocks the receptor