T1 L24: Headaches and migraines, 04/12/23, JG

Cranial Pain Sensitivity and Clinical Assessment

• Cranial structures have varying pain sensitivity, with pain-sensitive structures including cranial venous sinuses, arteries at the base of the brain, dura near the base of the brain, and extracranial nerves.
• Neurotransmitters and neuromodulators such as serotonin, dopamine, glutamate, oxytocin, noradrenaline, and neuropeptides play a role in pain modulation.
• The central nervous system structures involved in modulating pain include brainstem nuclei and peripheral ganglia.
• Clinical assessment of headaches involves phenotyping the headache, considering its site, load, character, precipitating factors, and previous history of headaches.
• Headaches are classified into primary and secondary categories, with primary headaches accounting for 99% of cases and being further subcategorized in the ICHD classification.
• Differentiating between primary and secondary headaches involves assessing the presence of red flags and fulfilling the criteria for specific headache types such as migraines.
• Red flags in clinical assessment indicating secondary headaches include age over 50 years, thunderclap onset, severity, rapid progression, specific triggers, systemic symptoms, and neurological signs.
• The absence of red flags provides confidence in diagnosing a primary headache.
• Diagnostic criteria for migraines include specific characteristics of headache attacks, duration, and associated symptoms like nausea, vomiting, photophobia, and phonophobia.
• Migraine types are differentiated based on the presence of migrainous features, duration, and associated symptoms.
• Migraines affect over 10 million people in the UK and are more prevalent in females than males.
• Treatment options for migraines include lifestyle adjustments, abortive treatments such as triptans and NSAIDs, preventative medications, and injectables like Botox and CGRP antagonists.