Clinical Perspectives of Headache Disorders Flashcards
What is the difference between a primary and secondary headache?
A primary headache has no identifiable cause, whereas a secondary headache is due to some underlying cause (tumor, hemorrhage, meningitis, etc).
True/False. The dura surrounding the vascular sinuses and vessels is pain insensitive.
False. While dura over the skull is pain insensitive, dura around vascular structures is pain sensitive
What are the pain-insensitive brain structures?
Brain parenchyma, ependyma, choroid plexus, pia matter, arachnoid, dura over the skull
The falx cerebri is pain (sensitive/insensitive)
Pain-sensitive
True/False. Drainage of CSF in the supine position reduces headache.
True. Draining CSF in the erect position causes the brain to compress pain-sensitive structures
Lesions above the tentorium refer pain where?
Forehead and behind the eye
Pain in the ear and back of the head is often due to lesions where?
Posterior fossa
What red flags indicate a potentially dangerous headache?
Systemic or neurologic symptoms, sudden onset, older age, prior history, pattern change
A patient comes to the clinic feeling unwell, with minimal neck movement. You check Kernig’s sign. What indicates a positive test?
Severe pain in the lower back
A physician flexes the neck of a patient with meningitis. What would be the expected reaction?
Flexion of the lower extremities to reduce pain - this is called Brudzinski’s sign
What is one of the common causes of subarachnoid hemorrhage?
Ruptured intracranial aneurysm
What is sentinel hemorrhage?
Leakage from a vessel into the subarachnoid space before rupture of an aneurysm
What symptoms characterize a subarachnoid hemorrhage?
Sudden onset of a very severe headache
What are the most common sites of aneurysms?
PCA, ACA, middle cerebral bifurcation
What is the most common type of migraine?
Migraine without aura
