HEADACHES

Question 1

headache

Answer 1

pain or discomfort located in the head or face area

vary greatly in pain location, pain intensity, and frequency

Question 2

nociceptors

Answer 2

pain is experienced when unpleasant stimuli activate sensory nerve fibres called nociceptors in skin, muscles, joints and some organs - these transmit pain signals from the periphery to the brain

Question 3

where are nociceptors found?

Answer 3

found in layers of tissue known as the dura and pia, and chemicals released from blood vessels near the dura and pia can activate nociceptors, resulting in headache

Question 4

primary headache

Answer 4

the headache itself is the main medical problem

Question 5

primary headache triggers

Answer 5

medications
dehydration
changing levels of hormones

Question 6

cluster headache

Answer 6

usually occur in a series that may last weeks or months, and the headache series may return every year or two

Question 7

common symptoms of cluster headaches

Answer 7

• severe pain on one side of the head, usually behind one eye
• the eye that is affected may be red and watery with a droopy lid and small pupil
• swelling of the eyelid
• runny nose or congestion
• swelling of the forehead

Question 8

secondary headache

Answer 8

symptom of a disease that can activate the pain-sensitive nerves of the head.

Question 9

danger symptoms that could be a clot (stroke) or tumour

Answer 9

• tension headache
• trauma/injury to neck or head
• cerebral vascular disorders (thunderclap)
• infection (ear/eye/nose/tooth)
• secondary to facial pain (sinus/mouth/eyes)
• psychiatric disorders (panic attacks/disorders)
• ADRs - rebound headache
• dehydration - hangover
• referred pain

Question 10

rebound headache

Answer 10

• overuse of painkillers
• caffeine heavily implicated headaches may be caused by conditions such as disorders of the neck, eyes, brain, jaw or teeth

Question 11

who are migraines most likely to affect

Answer 11

• rare in U12
• more common in women

Question 12

symptoms of migraine without aura (primary headache)

Answer 12

• attacks lasting 4-72 hours
• unilateral location
• pulsating quality
• moderate or severe pain intensity
• aggravation by or causing avoidance of routine physical activity
• nausea and/or vomiting
• photophobia
• phonophobia

Question 13

migraine triggers

Answer 13

• stress and other emotions
• biological and environmental conditions, such as hormonal shifts or exposure to light and smells
• fatigue and changes to sleep pattern
• glaring or flickering lights
• weather changes
• certain foods and drinks

Question 14

why are migraines considered vascular headaches

Answer 14

increased blood flow can also trigger a migraine

Question 15

migraine

Answer 15

• throbbing with hypersensitivity to light, sound and touch
• usually frontotemporal
• in children and adolescents often more bilateral
• can be associated with cranial autonomic symptoms and symptoms of cutaneous allodynia
• migraine without aura has a menstrual relationship (5-HT/oestrogen levels change)

Question 16

aura symptoms

Answer 16

• visual
• sensory
• speech and/or language
• motor
• brainstem
• retinal

Question 17

migraine with aura symptoms

Answer 17

• aura symptom spreads gradually over 5 minutes or more
• 2 or more symptoms occur in succession
• each individual aura symptom lasts 5-60 min
• 1 or more aura symptom is unilateral
• 1 or more aura symptom is positive
• aura accompanied or followed in <60 min by headache

Question 18

treatment of primary headaches

Answer 18

paracetamol
ibuprofen
codeine
bulizine
triptans
propanolol
pizotifen

Question 19

paracetamol moa

Answer 19

acts in inhibition of prostaglandin production in pain pathway

also in activation of descending serotonergic pathways

Question 20

ibuprofen moa

Answer 20

act on COX-1 and COX-2 receptors to inhibit production of prostaglandins in pain pathway

Question 21

codeine moa

Answer 21

acts centrally, has limited effectiveness on its own and works better in combination products

Question 22

buclizine moa

Answer 22

antihistamine with anti-emetic properties, also sedating (in migraleve pink)

Question 23

triptans moa

Answer 23

sumatriptan, zolmitriptan, rizatriptan

selective 5-HT serotonin receptor agonists with high affinity for 5-HT1B and 5-HT1D receptors

stimulation of the 5-HT1B receptors on smooth muscle cells of blood vessels causes cranial vasoconstriction

Question 24

propanolol moa

Answer 24

beta blocker reduces blood flow

interacts with rizatriptan

Question 25

pizotifen moa

Answer 25

acts on serotonin, histamine and tryptamine reducing blood flow and alters pain threshold in migraine

Question 26

what aches when you have a secondary headache

Answer 26

- a network of nerves that extends over the scalp - certain nerves in the face, mouth, and throat - muscles of the head, neck and shoulders - blood vessels found along the surface and at the base of the brain (contain delicate nerve fibres)

Question 27

tension headache

Answer 27

most common stress and muscle tension are often factors in tension-type headaches

Question 28

common features of a tension headache

Answer 28

- slow onset - bilateral - pain is dull or feels like a band around the head - pain may involve the back (posterior) part of the head or neck - pain is mild to moderate but not severe

Question 29

dangerous causes of a headache

Answer 29

blood clots thunderclap brain tumour

Question 30

thunderclap

Answer 30

rapid onset severe e.g. haemorrhagic stroke or other underlying vascular problem

Question 31

secondary headache treatment options (7)

Answer 31

NSAIDs (paracetamol, ibuprofen, codeine) muscle relaxants (diazepam) anti-bacterial decongestants (pseudoephedrine, xylometazoline) anxiolytics amitriptyline gabapentin/pregabalin/carbamazepine

Question 32

non-pharmacological interventions for headaches

Answer 32

- plenty of rest - plenty of water - relax (stress can make headaches worse) - exercise - avoid triggers