HA

Question 1

Most common neurological disordrer

Answer 1

HA
50% + americans report at least 1 HA per year.
1/3 people have severe headaches.

Question 2

__% of HA are high risk

Answer 2

1%

Question 3

Most headaches are caused by ____ or ____ problems

Answer 3

Muscle contraction or blood flow

Question 4

How many different types of HA

Answer 4

over 100

Question 5

3 types of primary HA

Answer 5

Tension-Type Headache (TTH): 78%
Migraine: 13-18%
Cluster: 0.4%

Question 6

Common location of:
TTH
Migraine
Cluster

Answer 6

TTH: Pain like a band squeezing the head. Across forehead.

Migraine: Unilateral. Visual changes are typical of classic form.

Cluster: Pain is in and around 1 eye. (but does not originate in eyes)

Question 7

Are primary or secondary more commonly associated with severe findings?

Answer 7

Secondary. HA caused due to systemic problem.

Question 8

Secondary headaches may be due to

Answer 8

Fasting
Sinusitis
Infections- meningitis, dental abscess. 
Stroke
Trauma 
Tumor 
Refractive/ocular disease. Less urgent. 
Medication over use

Question 9

HA red flags

Answer 9

• New HA type in pt over 50
• HA increasing in frequency or severity
• HA wakes pt from sleep
• HA + systemic finding such as fever or coughing/straining
• HA + neurological symptoms. Numb, tingling, slurred speech
• HA + papilledema
• HA with altered mental status. Confusion, memory probs
• HA with nausea or vomiting if NEW.

Question 10

majority of all HA

Answer 10

TTH

Question 11

TTH two types

Answer 11

Acute/episodic or chronic (15+ days per month)

Question 12

TTH more common in women or men

Answer 12

Women

Question 13

Why are TTH due to a dysfunction of pain perception

Answer 13

Persistent myofascical input (constant contracting muscle somewhere) causing pain and sterile inflammation (No infection)

Question 14

Signs and symptoms of TTH

Answer 14

Bilateral, dull, band like tightness 
4-6 hours 
No photophobia or phonophobia (hearing sensitivity)
Doesn't worsen with physical activity 
Responds to OTC meds

Question 15

TTH causes

Answer 15

Emotional/physical stress
depression and anxiety
Working in awkward positions- Tech neck.

Question 16

TTH Tx

Answer 16

OTC NSAIDS
Caffeine
Exercise
Stress reduction therapy

Question 17

How much of the population is affected by migraines

Answer 17

13%

Female> Male

Question 18

Migraineurs

• Most prevalent in ages:
• __% have immediate family Hx
• History of
• Strong correlation with

Answer 18

25-55 years old (may be associated with arteriolosclerosis)
70% with FHx
History with car sickness and vertigo as child
Strong correlation with depression/anxiety due to neurological differences in serotonin/dopamine.

Question 19

4 stages of a migraine

Answer 19

1. Prodrome
2. Aura
3. Attack/HA
4. Postdrome

Question 20

Migraine stage 1: Prodrome

Answer 20

1-2 days prior to attack 
These could be signs of a migraine coming: 
Constipation
Depression
Diarrhea
Drowsiness 
Irritability

Question 21

Migraine stage 2: Aura

Answer 21

occurs right before attack (20-30 mins)

Usually visual

Question 22

Migraine stage 3: Attack

Answer 22

Moderate to severe pain

lasts several hours- 3 days

Question 23

Migraine stage 4: Postdrome

Answer 23

Migraine hangover.
Malaise
Fatigue

Question 24

What is happening in the brain that causes a migraine?: Neurovascular theory

Answer 24

Neurobiology + Vascular function in the brain

Pt’s who get migraines have lowered threshold to stimuli, which leads to cortical hyper-excitability followed by cortical spreading depression (CSD). Excessive firing of neurons that activates trigeminal nerves and causes pain in dural blood vessels.

Hyper-excitability starts in occipital lobe and spreads to central sulcus.

Question 25

Cortical spreading depression (CSD)

Answer 25

Excessive firing of neurons that activates trigeminal nerves and causes pain in dural blood vessels.

Question 26

How to diagnose migraine using 54321

Answer 26

5 or more attacks 4 hours- 3 days in duration 2 or more of the following: Unilateral, throbbing, moderate/severe pain, causes avoidance of routine physical activity 1 or more of the following: Nausea, vomiting, photophobia, phonophobia

Question 27

Two main Migraine types

Answer 27

1. Migraine without aura (80%) Common migraine 2. Migraine with aura (20%) Classic migraine ``` Others: Retinal (not a true migraine) Childhood periodic syndromes Complication Probable migraine- hasn't met all 54321 criteria Chronic migraine ```

Question 28

Common migraine (without aura) has a 25% increased risk of ___ and ___

Answer 28

Stroke and MI

Question 29

What types of HAs improve with sleep

Answer 29

Migraines

Question 30

Signs/symptoms of common migraines without aura

Answer 30

Progressively worsen, unilateral, throbbing Nausea, vomiting photo and phono phobia Anorexia Improves with sleep Conj injection and tearing due to neuromuscular prob

Question 31

In what type of migraine might you see conjunctival injection and tearing

Answer 31

Common and classic

Question 32

How does 54321 change with classic migraine (with aura)

Answer 32

24321 | Only have to have 2 attacks, not 5

Question 33

Migraine with aura (classic migraine) has 2x risk of ___ in women and ____

Answer 33

MI in women | Ischemic stroke in male/females

Question 34

Fancy name for migraine with aura

Answer 34

scintillating scotoma

Question 35

How does a scintillating scotoma (aura) progress?

Answer 35

may last 20-60 mins. 1. Initial paracentral scotoma 2. Enlarging scotoma 7 mins alter 3. Scotoma obscuring much of central vision 15 mins later 4. Break up of scotoma at 20 mins

Question 36

Pts may have aura without headaches. More common in

Answer 36

Men over 40

Question 37

Retinal migraine is due to

Answer 37

Vascular spasm causing an interruption in ciliary or retinal circulation. Visual disturbances are result of retinal ischemia. Amaurosis fugax- may be due to stroke. Sudden loss of vision in 1 eye.

Question 38

Signs/symptoms of retinal migraines

Answer 38

Transient, monocular visual disturbance Usually brief HA before or after the visual episode Usually under age of 40

Question 39

Most common cause of transient vision loss under age 45

Answer 39

Aura

Question 40

Ocular manifestations of migraines

Answer 40

Aura Hemianopsia: Persistant VF defect up to weeks after attack. Horners syndrome- rare Normal tension glaucoma- associated

Question 41

Normal tension glaucoma is associated with

Answer 41

Ocular manifestations of migraines

Question 42

Are OTC meds effective for migraines?

Answer 42

Usually no

Question 43

How to tx migraines

Answer 43

Prophylactically Abortive tx- take in the moment to decrease severity or duration Avoid triggers- food, alcohol, stress, lights, smells

Question 44

Cluster headaches

Answer 44

Severe, unilateral pain usually involving the eye. Attacks occur in clusters- last for weeks to months. Headaches last 15-180 mins. May occur once every other day or up to 8x per day.

Question 45

How common are cluster headaches, in which genders and what are risk factors?

Answer 45

Men 0.4%, women, 0.08% | 80% are heavy smokers and 50% are alcoholic users

Question 46

What makes cluster headaches so painful?

Answer 46

Involves changes to the trigeminal pain processing.

Question 47

Autonomic features of cluster HA

Answer 47

Nasal congestion, facial sweating, lacrimation, conj redness, mitosis, and ptosis. Usually unilateral.

Question 48

TMJ syndrome

Answer 48

Pain in trigeminal and facial nerve areas Originates in the jaw and worsens with chewing Differentiating sign: Jaw clicking or locking. 5% of population, ages 15-40. F>M

Question 49

Ocular causes of HA

Answer 49

``` Angle cosure Uveitis Scleritis Optic neuritis Refractive disorders and muscle imbalance Metastatic orbital tumors Severe dry eyes ```

Question 50

Ophthalmodynia periodica-

Answer 50

Shooting eye pain that diminishes quickly in one eye. ``` Prob occurs along CN V ophthalmic branch. Often hx of migraines Benign Cause unknown Tx art tears ```

Question 51

Benign Episodic pupillary mydriasis

Answer 51

Acute, unilateral mydriasis. Blown pupil. Always co-manage with neuro. Women> men Hx of migraines associations: Blur, light sensitivity, HA. Similar to dilated symptoms.

Question 52

Headache work up

Answer 52

``` History Cranial nerve eval Sinus eval Blood pressure refraction Binocular/accom testing Complete ocular health assessment Visual field testing Refer to neuro ```

Question 53

Consider brain scan if you suspect

Answer 53

``` Tumor hx of seizures Recent head trauma Signifcant changes to HA Abnormal neuro signs ```