Headaches

Question 1

What are the types of headaches mentioned in the text?

Answer 1

• Migraine
• Menstrual migraine
• Tension-type headache
• Trigeminal Autonomic Cephalgias (cluster headaches)
• Other (cough, exercise, cold, or sex-induced)

Each type has distinct characteristics and classifications.

Question 2

What is a migraine characterized by?

Answer 2

• Moderate to severe throbbing or pulsating pain
• Usually worse on one side of the head
• Aggravated by physical activity

Migraine often starts at menarche and peaks during midlife.

Question 3

What are the diagnostic criteria for migraines?

Answer 3

• At least 5 attacks
• Each lasting 4-72 hours
• At least one of the following symptoms: photophobia, phonophobia, nausea and/or vomiting

These criteria help in identifying migraine cases.

Question 4

What is an aura in relation to migraines?

Answer 4

• Neurological symptom occurring before or at the onset of a migraine
• Usually visual
• Lasts about 20 minutes

Aura occurs in only about 20% of migraine attacks.

Question 5

What are the two subtypes of menstrual migraines?

Answer 5

• Pure menstrual migraine
• Menstrually related migraine

Pure menstrual migraine affects less than 10% of premenopausal women with migraines.

Question 6

What is the role of hormone therapy (HT) in migraines?

Answer 6

• May help prevent falling estrogen levels
• Can increase stroke risk, especially in smokers and higher doses of estrogen

HT’s impact varies based on individual circumstances.

Question 7

What are the treatment options for migraines?

Answer 7

• Abortive therapy for acute pain
• Preventative therapy

Treatment options can include medications and lifestyle adjustments.

Question 8

What is included in abortive therapy for migraines?

Answer 8

• Avoiding triggers
• Aspirin or acetaminophen combinations with caffeine
• Antiemetics for nausea
• Triptans (contraindicated in cardiovascular disease)
• NSAIDs often recommended with triptans

Abortive therapy is aimed at relieving acute migraine pain.

Question 9

What is the recommended preventative treatment for menstrual migraines?

Answer 9

• NSAID or triptan 2 days before expected onset
• Treatment for usual length of symptoms (5-7 days, twice daily)

Daily treatment may be necessary for irregular periods.

Question 10

What are some first-line preventative medications for migraines?

Answer 10

• Beta-blockers
• Candesartan
• TCAs (nortriptyline, amitriptyline)
• Anticonvulsants (topiramate, divalproex)

Preventative medications should be started low and increased slowly.

Question 11

What are some non-prescription options for migraine prevention?

Answer 11

• Magnesium
• Riboflavin
• Butterbur
• Feverfew
• Coenzyme 10
• Botox

These options can be considered alongside other treatments.