what is the difference between a headache and a migrane?
a headache is a symptom (can be a symptom of many disorders and conditions) and a migrane is an actual DIAGNOSIS
Where do headaches come from or originate?
may come from pain sensitive structures of the head
What are the most common areas of the brain that need to be evaluated?
intracranial (in the brain) and extracranial (outside the brain) structures
- extracranial structures include:
1) skull fractures, or inflammation on the lining of skull
2) inflammation on or near teeth
3) inflammation of skin over top of skull
4) tension spots in the back of the head and neck (muscle)
5) Hurting of the muscles of the face and forehead
6) sinuses can cause tension type headaches
Intracranial structures include:
1) lining of brain (meningis)
2) eyes
3) blood vessels in the brain
What nerves innervate the head? and at which locations? how do these nerves cause headaches?
the intracranial structure above the tentorium (right above cerebellum) are innervated by trigeminal nerve (CN V)
the intracranial structure below the tentorium (below the cerebellum) are innervated by cervical nerves
when these sensory nerves are inflammated and sensitized (repeated administrations of stimulus causing progressive amplification of response) is common to more than one cause of headache
What is the overall process of how headaches occur?
pain sensitive structures in the brain (in the paravascular area) become sensitized and release inflammatory mediators called CGRP and substance P, these inflammate the trigeminal nerves and make them sensitized therefore causing pain
What are 5 common headache patterns?
- first or worst headache (first headache with the highest intensity) can be dangerous
- recurring headache with autonomic features swelling of eyes, sinuses, runny nose..etc..
- episodic headache
- high frequency and chronic headache
- progressive headache
the temporal pattern/how often it occurs can say alot about the underlying cause of the headache
What is an example of a first or worst headache? What does it indicate?
an example: Thunderclap headache
- reaches to 7/10 or more in one minute
- it is a subarchanoid hemorrhage most of the time or related to other vascular problems in the brain like:
1. RCVS (Reversable vasoconstriction syndrome) occurs when u do certain drugs, results in a basal spasm of middle cerebral artery and then it goes away)
2. ceberal artery dissection
3. pituitary apoplexy
4. sinovenous thrombosis
5. PRES
or from other things like infections..e.tc..
this headache should NEVER be missed because its deadly
What are 3 ways we can assess thunderclap headaches?
- CT Scan
- CT angiogram
- Lumbar puncture for infections
What are trigeminal autonomic cephalagias?
they are short but tense headacheds associated with autonomic features and differentiated by duration
cluster headaches are most common and last 15-45 mins
What are some characteristics about cluster headaches?
- person tends to want loud noises and high stimulation (not quiet and peace) to get passed it
- oxygen is a useful treatment for acute attacks
- usually immetrix is taken
What is an episodic headache? when does it occur?
- recurrent moderate to severe headache
- usually a migrane with or without vomiting, it could be bilateral or unilaterual, photophobia (cant stand light) and phonophobia (cant stand sounds) and gets worse if u continue with ur activity
99% of ppl who get these have normal brain imaging
What are 3 types of headaches according to the international classification of headache disorders?
- primary headaches: incl. migranes, tension-type headache and trigeminal autonomic cephalagias (cluster headaches) [reccurent, benign and not serious]
- secondary headaches: caused by other conditions
- painful cranial neuropathies (caused by other medical conditions and trauma/nerve damage)
How does headache change with age?
- as you get older, migranes and tension-type headaches become more common
- 25% of people will change their headache type
- half of the people will get worse or improve (1 in 20 will get worse)
What is prevalence of migranes in children?
less than 5% in children under 12
and 10-15% in children over 12
usually occurs in females more after puberty
How do migranes start?
via things that turn the inflammated pathway on:
- aura’’s (cortical spreading od depolarization which triggers sensitization of trigeminal nerves)
- barometric pressure changes can also cause inflammation
What is the basic process of a migrane in the brain?
- migranes are through to start in the dorsal raphe nucleus and locus coerelus
- it then travels to the trigemino-vascular unit in archnoid membrane (where blood vessels dialate) via parasympathetic output
- this parasympathetic output also causes autonomic region activation which causes running nose, and sinuses..etc..
- from the dorsal raphe nuclei and locus corelus it also goes to the hypothalamus via the SSN and produces changed barometric pressure changes and stress (this is why u feel thirsty or hungry or feeling weird right before a migrane)
What are auras and how are they formed?
aura and cortical spreading can be triggered in any mammilian brain;
rise and fall of blood flow and disturbances in vision and perceptions
- waves of depolarization start from the occipital lobe and travel forward to the frontal lobes at about 3mm/s
- postive aura is gaining of function like seeing a light
and negative aura is loss of function like thirst..etc.. before a migrane
What are some key features that distinguish a migrane from any other type of headache?
- its usually unilateral
- it pulses
- you really want no sound and no light
- physically impaired activity (cant continue what u were doing before)
How are migranes presented in children?
- shorter in duration and less than 1hr
- non pulsatile
- often bilateral instead of unilateral
- other somatic symptoms like abdominal pain (i.e. abdominal migranes)
what are the 3 phases of migrane attack and what happens during the phases? When is the best period for treatment?
- premonitory phase: hypothalamus plays a key role in increasing fatigue, urination, yawning, thirst..etc.. occurs before a migrane
- pain/headache phase: peripheral trigeminal cranial nerves fire and are sensitized
- recovery: not your normal self for 28/48 hours
the best time for treatment is right after the premonitory phase but before the headache phase
How does the assessment for migranes go?
- asking about the history of the patient:
- when did their first headache begin
- what has been happening over time
- description of typical headache
- establish treatment expectatons
What is a minimum examination for patients who come in with headache problems?
- BP and temperature
- head circumference for hydrocephalus
- fundoscopy (seeing inside of eyes)
- posture and examination of gait
- palpation of head and neck
- skin
What are some predictors of abnormal imaging?
- “first” “worst, thunderclap or progressive
- focal motor findings
- unsteady gait/ataxia
- altered level of consciousness
- signs/symptoms of raised ICP (intracranial pressure)
- hypertension (high BP) and tachycardia (fast heart rate)
- young age (kids shouldnt be getting headaches typically)
What is the best practice for migranes and headaches?
best drug/right dose/right time
- early treatment (15 to 30 mins from onset) is ideal
- appropriate dose and rapidly absorbed preperation
- combine with metoclopramide (to reduce neseauousness and acid reflux)
- do not take opiods or butalbital-containing meds because that will cause more migranes
avoid medication overdose: more than 2-3 doses per week
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Introduction29
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Clinical and Research techniques for investigating the human Nervous system35
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Functional Anatomy of the Central Nervous System17
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Principles of Neural Signalling28
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Brain Embryology32
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Headache Lecture36
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Memory Disorders (amnesias)46
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Intellectual Disability52
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ASD (Autism Spectrum Disorders)29
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Pain: A neurobiological perspective44
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Spinal Cord Injury37
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The Neurology of Sleep52
