Clinical Correlations With Headaches Flashcards Preview

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Flashcards in Clinical Correlations With Headaches Deck (21)
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1
Q

Primary vs secondary headaches

A

Primary = recurrent headaches that originate form the head and have no other associated causes

Secondary = headaches that’s are caused by something else and are often isolated events (don’t reoccur)

2
Q

Examples of secondary headaches

A

Referred pain from neck/eyes/sinuses/teeth/jaw/nose/mouth

Trauma to the head or neck

Intracranial or cervical vascular disruption

Substance abuse or withdrawal

Infections within sinuses, respiratory tract, dental or CNS

Psychiatric disorders

3
Q

What is the most common type of primary headaches

A

Tension (40%)

Migraines (10%)

Cluster (1%)

4
Q

Tension headaches

A

most common headache syndrome

Characteristics

  • mild-moderate intensity
  • bilateral
  • non throbbing and has a “band-like” appearance in the fronto-temporal,occipital and TMJ regions.
  • minimal features and associated symptoms
  • unremarkable PE

Treatment:
- NSAIDs=, acetaminophen, ASA, OMT, herbal remedies.

5
Q

Why should you limit any abortive headache medications to less than 2 times a week?

A

If using 3 or more time, causes rebound headaches due to withdrawal

6
Q

Migraines

A

Roughly 10% of the population gets these

Risk factors

  • genetics (defects in the trigeminal nerve signaling pathways)
  • age (starts when teenager, peaks in 30s-40s and declines with age)
  • gender (women more likely than men)
  • hormones (withdrawal of estrogen and menopause encourages it and haunts it respectively.)
  • diet, environment and lifestyle triggers

Characteristics of migraines

  • moderate- severe
  • unilateral
  • throbbing and pounding headache
  • accompanied by nausea, vomiting, photo/phonophobia
  • is disabling
  • lasts 4-72 hrs
7
Q

Chronic migraines is characterized by what?

A

15 or more migraines a month for 3 months

8
Q

Status migrainosus

A

A migraine that lasts over 72 hrs.

This is an emergency

9
Q

Phases of a migraine

A

1) Premonitory/prodromal
- starts hours/days before a migraine
- photo/phonophobia
- increased urination/ diarrhea
- fatigue and mood changes

2) aura stage
* ONLY OCCURS IN 20-30%*
- lasts 5-60 minutes and occurs usually before the headache (but now always)
- visual or sensory lines
- speech/language disabilities
- motor strength defects

3) headache stage
- lasts under 72 hrs

4) postdrome (migraine hangover)
- lasts up to 72 hrs after the migraine
- depression
- increased sleepiness and decreased concentration

10
Q

Most common environmental triggers

A

Stress (80%)

Hormone changes (65%)

Fasting (57%)

Weather changes (53%)

Sleep disturbances (50%)

Neck pain/tension (38%)

Lights and alcohol (38%)

Heat (30%)

Exercise (22%)

Sex (5%)

11
Q

What is special considerations for patients with aura migraines

A

Birth control pills are contraindicated

Triptans are contraindicated

Consider preventative emend actions for sure patients

Increased aura rates are present with increased risks of strokes

12
Q

What neuropeptide is most likely associated with migraines

A

CGRP proteins

13
Q

When is dexamethasone used for headaches?

A

For repetitive headaches

Calms down the inflammation that occurs with repetitive headaches

14
Q

When is medications for migraines (triptans and ergots) indicated

A

1) any patient who gets migraines 4times or more a month
2) any patient that experiences aura migraines
3) any patient that experiences rebound headaches
4) any patient who’s headaches are so severe that NSAIDs, OTCs, and lifestyle changes aren’t working and its debilitating

15
Q

What are the 4 main classes of migraine preventative medications?

A

1) BBs
2) CBBs
3) antidepressants (amitriptyline and sertraline)
4) anticonvulsants (gabapentin, topiramate)

16
Q

Cluster headaches

A

Risks

  • genetics (HCRTR gene mutations)
  • being male
  • age 20-45

Symptoms:

  • literally the worst pain ever behind the eye
  • starts abruptly and is unilateral behind the eye
  • produces at least one of lacrimination/rhinorrhea, conjunctival injection, sweating or horners syndrome.
  • inability to comfortable (patient paces around the whole time)
  • comes in clusters (roughly 2/day for a month or so and then go away for the rest of the year or altogether)
17
Q

What is the hypothesis behind cluster headaches

A

Abnormal hypothalamic initiation/signaling which causes dilation of blood vessels around the trigeminal nerve

18
Q

Trigeminal neuralgia (tic douloureux)

A

A secondary type of headache that is usually caused by CN 5 compression from a mass of demyelination fo the CN5 via MS

Same pain characteristics as cluster headaches

Treatment:
= anticonvulsants or surgical decompression
And treatment of primary disorder.

19
Q

Paroxysmal hemicrania

A

Severe headaches similar to cluster headaches that are short in duration (2-40min) and occur multiple times per day (2-40 times)

Much more common in women

Does not start at night and has no time pattern

20
Q

Treatment of cluster headache

A

O2 high flow on non-rebreather mask

Triptans are next after oxygen

can use vagal nerve stimulator but doesnt work on all

21
Q

What are red flag warnings associated with headache patients

A

1) thunderclap headache
- subarachnoid hemorrhage caused by bridging vein aneurysms or collagen vascular disorders

2) focal neuro local signs or symptoms associated with the headache
- arterovenous masses of cancer can be the cause

3) headaches triggered by cough sneezing or sex
- can be imaging if you rule everything else out first

4) Headache with personality changes or neck stiffness
- meningitis/encephalitis or cancer

5) headache with severe ocular pain and decreased vision/halos around the lights. Also pupil is dilated
- this is acute closure glaucoma and is a surgical emergency

6) headaches that get much worse when bending over and abnormal neurological exams = cancer
7) papilledema present
8) immunosuppressive patients with new headaches

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