Clinical Care-Headaches

Question 1

overview of tension headaches

Answer 1

bilateral
vice like in nature
exacerbated my emotional stress, fatigue, noise, glare
may be associated with hypertonicity of neck muscles

Question 2

diagnostic test for tension headaches

Answer 2

none

Question 3

treatment of tension headaches

Answer 3

NSAIDS (iburopfen 400-800mg q 4-6 hrs, max 2400; Naproxen 250-500 every 12 hrs. )

Tylenol-max 4 g

Question 4

sx and symptoms of tension headaches

Answer 4

dull, aching pain in large areas of head

tightness/pressure across forehead and or side and back of head.

tenderness on scalp, neck, shoulder muscles

Question 5

overview of cluster headaches

Answer 5

“suicide headaches”

usually affect middle aged men
unilateral pain that starts around the temple or eye
patient is often restless

episodes often occur 15 to 3 hrs.

seasonally and grouped together

Question 6

associated symptoms of cluster headaches

Answer 6

ipsilateral congestion or rhinorrhea
lacrimation and redness of eye
Horner syndrome (ptosis, miosis, anhidrosis)

Question 7

treatment of cluster headaches (imitrex)

Answer 7

inhaled oxygen for 15 min is initial treatment

subcutaneous sumatriptan (Imitrex)- 6 mg, may repeat > or = 1 hour after initial dose. (2 doses max in 24 hrs)

Adverse reaction of: tingling, vertigo, feeling hot.

contraindications: ischemic heart disease, hx of cerebrovascular syndrome, history of hemiplegic or basilar migraine; peripheral vascular disease. uncontrolled hypertension.

Question 8

treatment of cluster headaches (Zomig)

Answer 8

oral zolmitirptan- oral anti migraine medication if they are able to tolerate.

dose: 2.5 mg. may be repeated if needed > or = to (10 mg in 24hr)

adverse reactions: GI unpleasant taste, chest pain, weakness, dizziness/vertigo, feeling hot

Question 9

overview of migraines

Answer 9

gradual build up of a throbbing headache, unilateral or bilateral

several hours duration

aura may or may not be present

a) visual disturbances (stars, lights, sigzags)
b) focal disturbances such as aphasia, tingling, weakness in circumscribed distribution

family HX

nausea/vomiting

Question 10

how is the diagnosis made for migraines

Answer 10

clinically by HPI

Question 11

management of migraines

Answer 11

avoid precipitating factors, together with prophylactic or symptomatic pharmacological TX if necessary

Question 12

abortive treatment of migraines .

Answer 12

during attack- rest in a quiet, darkened room

NSAIDS: ibuprofen, naprosyn, aspirin, acetaminophen, ketoroloac. 30mg Iv/IM once every 6 hrs, or 60 mg IM. (120 max a day)

sumatriptan: single dose of 25 mg, 50mg, or 100mg taken with fluids. 2nd dose allowed > 2 hrs.

zolmitriptan : 2.5 mg, may repeat > 2 hours. 10mg max in 24 hrs.

Question 13

migraine prophylaxis

Answer 13

antihypertensive: propranolol, metoprolol

Propranolol:
two divided doses starting at 40 mg; 40-160 mg daily
adverse reaction: CHF, bradycardia, heart block, bronchospams, hepatitis

antidepressants: amitryptiline
10mg at bedtime; 20-50mg at bedtime
Side effects: drowsiness, dry mouth, constipation, tachycardia, palpitations, orthostatic hypertension, weight gain, blurred vision, urinary rentetion.

Question 14

post traumatic headache overview

Answer 14

sx occur within 1-2 days of injury.

accompanied by impaired memory, poor concentration, emotional instability, and increased irritability.

Question 15

treatment of post traumatic headache

Answer 15

no special treatment

simple analgesics are appropriate

Question 16

medication overuse headache overview

Answer 16

present in about 50% of patients with chronic daily headaches

chronic pain or with complaints of headache unresponsive to medication

hx will often reveal heavy use of analgesics

Question 17

treatment of overuse headache medication

Answer 17

treatment is to withdraw medication

expect improvement in months, not days.