Headaches


 * Types of Headaches

** • **Cluster **- less common type · Tend to be episodic · 1-8 headaches/day possible followed by remission · Vasoreactivity in the hypothalmus implicated as cause · Pain is the forehead, temporal, and around the eyes · Also may include nasal congestion and tearing (one sided) • **Tension **<span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;">-Most common type <span style="color: black; font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msobidifontweight: bold; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;">Doesn’t usually interfere with daily activity <span style="color: black; font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msobidifontweight: bold; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;">Conflicting hypotheses of mechanism <span style="color: black; font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msobidifontweight: bold; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;">Neck and shoulder muscle tension-symptoms but not cause <span style="color: black; font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msobidifontweight: bold; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;">Related possible causes: psychogenic stress, oromandibular dysfunction, depression <span style="color: black; font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msobidifontweight: bold; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;">Treatment: <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman'; msolist: Ignore;">1. <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;">ASA, NSAIDs, acetomenophen <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman'; msolist: Ignore;">2. <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;">Nonpharm: acupuncture, biofeedback, PT <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman'; msolist: Ignore;">• **<span style="background: lime; color: black; font-family: 'Times New Roman','serif'; mso-highlight: lime;">Migraine **<span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;">-mech possibly r/t arterial inflammatory process (Two categories) <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman'; msolist: Ignore;">1. <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;">Common-no aura—85% are this type <span style="color: black; font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msobidifontweight: bold; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;">Pulsatile, throbbing, unilateral, visual disturbances <span style="color: black; font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msobidifontweight: bold; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;">n/v, photophobia, sensitivity to sound, <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman'; msolist: Ignore;">2. <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;">Classic-pain preceded by aura <span style="color: black; font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msobidifontweight: bold; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;">Similar symptoms as those listed above and <span style="color: black; font-family: Symbol; mso-bidi-font-family: Symbol; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msobidifontweight: bold; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;">Aura- Visual & motor function disturbances that begin 5-20 minutes prior to head pain. n/v

<span style="background: lime; color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; mso-highlight: lime; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman'; msohighlight: lime; msolist: Ignore;">• **<span style="background: lime; color: black; font-family: 'Times New Roman','serif'; mso-highlight: lime;">Migraine headaches  ** <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman'; msolist: Ignore;">– <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;">Severe, throbbing headaches on one side of the head <span style="background: lime; color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; mso-highlight: lime; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman'; msohighlight: lime; msolist: Ignore;">• **<span style="background: lime; color: black; font-family: 'Times New Roman','serif'; mso-highlight: lime;">Cluster headaches ** <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman'; msolist: Ignore;">– <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;">Begin during sleep; sharp, steady eye pain, sweating, flushing, tearing, and nasal congestion <span style="background: lime; color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; mso-highlight: lime; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman'; msohighlight: lime; msolist: Ignore;">• **<span style="background: lime; color: black; font-family: 'Times New Roman','serif'; mso-highlight: lime;">Tension headaches ** <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman'; msolist: Ignore;">– <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;">dull band of pain around the entire head
 * <span style="background: yellow; color: black; font-family: 'Times New Roman','serif'; mso-highlight: yellow;">Key symptoms: **<span style="color: black; font-family: 'Times New Roman','serif';">

<span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;">Ergot Derivatives: **Ergotamine** <span style="color: black; font-family: 'Times New Roman','serif';"> <span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;"> <span style="color: black; font-family: 'Times New Roman','serif';">
 * <span style="color: black; font-family: 'Times New Roman','serif';">Prototype drug for migraine headaches: Ergotamine **
 * <span style="color: black; font-family: 'Times New Roman','serif';">Action: **<span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;">The ergot derivatives block alpha-adrenergic and serotonin receptor sites in the brain to cause constriction of cranial vessels, a decrease in cranial artery pulsation, and a decrease in the hyperperfusion of the basilar artery bed.
 * <span style="color: black; font-family: 'Times New Roman','serif';">Indication: **<span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;"> They are indicated for the prevention or abortion of migraine or vascular headache.
 * <span style="color: black; font-family: 'Times New Roman','serif';">Adverse reactions: **<span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;">Numbness, tingling of extremities (fingers and toes), muscle pain in the extremities, pulselessness or weakness in legs, precordial distress, tachycardia, bradycardia, arrhythmias, ergotism (chest pain, nausea, vomiting, diarrhea, severe thirst, hypoperfusion, confusion)
 * <span style="color: black; font-family: 'Times New Roman','serif';">Pharmacokinetics: Route: **<span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;">Sublingual **Onset: **Rapid** Peak: **0.5-3h
 * <span style="color: black; font-family: 'Times New Roman','serif';">Drug-to-drug interactions: **<span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;">Beta blockers, the risk of peripheral ischemia and gangrene is increased
 * <span style="color: black; font-family: 'Times New Roman','serif';">To prevent migraine headaches: **<span style="color: black; font-family: 'Times New Roman','serif'; mso-bidi-font-weight: bold;"> Anti-inflammatory therapy, NSAIDs, Vascular smooth muscle relaxation—exact mechanism of therapy not well understood, Beta-blockers and Calcium channel blockers