Migraine Cluster Headache
Headache
Describe an approach to the classification of headaches, and list the main causes in each group
Chronic, continual
Tension headache
Analgesic- dependent headache
Chronic, episodic
Migraine
Cluster headache
Subacute, evolving
Raised intracranial pressure
Meningo-encephalitis
Giant cell arteritis
Acute, severe
Subarachnoid haemorrhage
Describe the clinical features of migraine and tension type headaches
Migraine
Repeated episodes of moderate or severe throbbing pain lasting 4-72hr
Often unilateral, aggravated by movement
Nausea and vomiting
Photophobia
Phonophobia
Visual disturbance- blurred vision or an arc of scintillating zigzags slowly spreading across the visual field
Pallor
Common aura symptoms include: visual disturbances – such as flashing or flickering lights, zigzag lines, blurred vision, temporary blindness numbness or a tingling sensation – common in the hands, arm or face, similar to ‘pins and needles’ slurred speech poor concentration problems with your co-ordination
Tension headaches
Bilateral – band like non-pulsatile headache ± muscle tenderness no vomiting or sensitivity to head movement tight band around head, often radiating into the neck- due to chronic contraction of facial and neck muscles. Describe the pathogenesis of migraine
The cause of migraine remains controversial. The headache is due to vasodilation or oedema of blood vessels, with stimulation of the nerve endings near affected extracranial meningeal arteries. Release of vasoactive substances such as NO, 5-hydroxytryptamine, and the neuropeptide calcitonin-gene-related peptide (CGRP) are all thought to play a role in the pathogenesis. Describe the mechanism of action and main side effects of drugs used to treat an acute migraine attack
Simple analgesia – acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol pain relief.
Side effects: nausea and vomiting
Antiemetic e.g. metaclopramide
Anti
Describe an approach to the classification of headaches, and list the main causes in each group
Chronic, continual
Tension headache
Analgesic- dependent headache
Chronic, episodic
Migraine
Cluster headache
Subacute, evolving
Raised intracranial pressure
Meningo-encephalitis
Giant cell arteritis
Acute, severe
Subarachnoid haemorrhage
Describe the clinical features of migraine and tension type headaches
Migraine
Repeated episodes of moderate or severe throbbing pain lasting 4-72hr
Often unilateral, aggravated by movement
Nausea and vomiting
Photophobia
Phonophobia
Visual disturbance- blurred vision or an arc of scintillating zigzags slowly spreading across the visual field
Pallor
Common aura symptoms include: visual disturbances – such as flashing or flickering lights, zigzag lines, blurred vision, temporary blindness numbness or a tingling sensation – common in the hands, arm or face, similar to ‘pins and needles’ slurred speech poor concentration problems with your co-ordination
Tension headaches
Bilateral – band like non-pulsatile headache ± muscle tenderness no vomiting or sensitivity to head movement tight band around head, often radiating into the neck- due to chronic contraction of facial and neck muscles. Describe the pathogenesis of migraine
The cause of migraine remains controversial. The headache is due to vasodilation or oedema of blood vessels, with stimulation of the nerve endings near affected extracranial meningeal arteries. Release of vasoactive substances such as NO, 5-hydroxytryptamine, and the neuropeptide calcitonin-gene-related peptide (CGRP) are all thought to play a role in the pathogenesis. Describe the mechanism of action and main side effects of drugs used to treat an acute migraine attack
Simple analgesia – acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol pain relief.
Side effects: nausea and vomiting
Antiemetic e.g. metaclopramide
Anti