Headache Flashcards
List some of the red flag symptoms
first/worst abrupt onset fundamental pattern change new headache & 50 yo cancer, HIV, pregnancy abnormal physical exam neuro sx <1hr later headache onset w/seizure or syncope, w/ exertion, sex or valsalva
List some of the comfort signs
stable pattern long-standing history family history of similar headahces normal physical exam consistently triggered by: hormonal cycle, specific foods, specific sensory input (light, odors), weather changes
Which type of headache is more common: primary or secondary?
primary
What are the 3 major types of primary headache?
migraine
cluster
tension-type
What are some causes of secondary headache?
Trauma Vascular infection metabloism oncologic inflammatory
What are the pain sensitive intracranial structures?
meningeal arteries
proximal portions of the cerebral arteries
dura at the base of the brain
venous sinuses
cranial nerves 5,7,9, 10 and cervical nerves 1,2, and 3
Which pain sensitive intracranial structures are innervated by V1?
meningeal arteries
proximal portions of the cerebral arteries
dura at the base of the brain
venous sinuses
When is imaging obtained for headache?
recurrent migraine with recent change in headache pattern, new onset seizures or focal neurologic signs or symptoms
What are common times of year for patients to expereince cluster headaches?
around the summer & winter solstices
What are the diagnostic criteria for cluster headache?
1/every other day to 8/day
must be: severe, unilateral oribtal/supraorbital and or/temporal location and last 15-180 minutes
plus have 1 of the following: conjunctival injection, lacrimation, rhinorrhea, nasal congestion, forehead and facial sweating, miosis, ptosis, eyelid edema
Can horner’s syndrome occur in a cluster headache?
yes
What are the diagnostic criteria for migraine?
headache attack last 4-72hrs
two of the following: unilateral, pulsating, moderate-severe intensity, aggravation by walking up stairs
one of the following: nausea, vomiting, photophobia and phonophobia
What are the 3 best predictors of diagnosis of migraine?
nausea, disability and photophobia
When do migraine aura’s usually occur?
~20 min before migraine
What are the diagnostic criteria for tension-type headache?
headache last hours or is continuous
two of the following: pressing/tightening quality (nonpulsating), mild/mod intensity, bilateral, no aggravation by walking up stairs/physical activity
no more than one of: photophobia, phonophobia, mild nausea, meither moderate or severe nausea nor vomiting
How high does pressure have to become in the sinuses to cause headache?
> 180mm Hg
What are not readily modifable risk factors for chronic daily headache?
migraine female sex low education low socioeconomic status head injury
What are readily modifiable risk factors for chronic daily headache?
attack frequency obesity medication overuse stressful life events snoring
What role does the trigeminovascular system play in migraine?
can generate or perpetuate pain
How can cortical neuronal hyperexcitability occur?
enhanced release of excitatory neurotransmitters -elevated plasma glutamate concentration -identified genetic mutations in FHM reduced intracortical inhibition low brain Mg2+ altered brain energy metabolism
What is cortical spreading depression?
wave of intense cortical neuron activity folowed b neuronal suppression (inc rCBF –> dec rCBF)
supp. often coincies with headache onset
How fast does CSD travel?
2-3mm/min
What is released during CSD that can lead to pain? (leaks out of neurons)
AA
NO
H+
K+
How does brainstem dysfunction contribute to initiating migraine?
dysfunction in areas involved in central control of nocicdption (PAG focal point)
facilitates activation and sensitization of TNC neurons?
