Headache Flashcards
Migraine pathophysiology?
cortical spreading depression/depolarizing wave
trigeminovascular system transmits the stimuli to pain (what is normal)
sensitization - nerves become hypesensitized so they have a higher magnitude of response (migraines) - tx ASAP
serotonin deficit
HA epidemiology?
90-95% are benign
1% are life threatening
Cluster pathophysiology?
activation of trigeminal -autonomic pathway
starts to tear
Tension HA pathophysiology?
start centrally
the common headache
CNS stimuli misinterpreted as pain
pain of the head muscles
Classification of headaches?
primary
secondary
Secondary HA - cx?
systemic infxn (when you have a cold, dehydrated) head injury* vascular disorders* subarachnoid hemorrhage* brain tumor* *rare *underlying condition
Secondary HA - cx?
systemic infxn (when you have a cold, dehydrated) head injury* vascular disorders* subarachnoid hemorrhage* brain tumor* *rare *underlying condition pituitary adenoma optic neuritis temporal arteritis
Concerning exam?
HTN, bradycardia, fever - LP (unless you can find the source) papilledema (d/t ICP) neck stiffness --> meningitis focal neurologic finding --> CVA ataxic gait
Concerning Hx?
“worst headache”
“thunderclap”-subarachnoid hemorrhage
onset of HA after 55yo (HA should be getting better)
recent change in pattern
HA w/ exertion (increased pressure –> aneurysm)
worsening despite tx
seeing holes/light/diplopia (abducens not working, glaucoma)
Common triggers of primary HA?
diet (caffeine)
stress
sleep
*finding trigger will help tx HA
Primary HA - tx?
HA subtype impact on ADL response to tx pt education (inherited? - control but will NEVER go away!) avoid triggers
Primary HA - tx failures?
wrong dx
wrong medication
suboptimal dosing
unrealistic expectation (they expect to be “cured” but they’re not so they get frustrated!)
Migraine diagnosis?
two of following: unilateral pain throbbing pain aggravating w/ movement mod/severe one of the following: N&V photophobia
Migraine HA - sx?
nasea photophbia lightheadnes scalp tenderness vomitting visual disturbances prodromal and aura
When to use prophylaxis of MHA?
recurring MHAs that interfere w/ ADL
5+/mo
failing tx/contraindication
prevent neurologic damage: hemiplegic migraine, migrainous infarct
Preventative therapy for MHA?
ASA - CVA pts
Naproxen - little more effective
B Blockers (propranolol) - good w/anxiety but causes fatigue
TCA = tension + MHA
Valproate - prolonged HA, aytpical migraines
Pt education for prophylatic MHA?
meds take wks - must be tried for 3 mo before “failed tx”
start low and slow, effective? - taper down after 6mo
MHA tx?
ASAP
once it starts - it doesn’t stop! –> pain relief (keep them comfortable)
just sleep it off
r/o concerning hx & PE
abortive therapy for MHA-mild?
1) Naproxen (do not give to peds and preg)
2) Tylenol
* BENADRYL!- adjunct (helps them sleep
abortive therapy for MHA-mod?
1) Excedrin
2) Triptan (acts on 5HT receptors- cxs vasoconstriction: chest pains)
-Sumitriptan
-Rizatriptan
LAST RESORT: Ergotamines
AVOID: opioids (Codeine - cx rebound HA)
*BENADRYL!!
Dexamethasone - to avoid rebound
abortive therapy for MHA-severe?
1) Ketorlac
2) Sumitriptan (SQ); dopamine agonist - Metoclopramide, prochlorperzine, droperidol) + benadryl
LAST RESORT: ergotamines (dihydroergotoamine) - do not give if they had triptan
AVOID OPIOIDS - cx rebound HA
Dexamethasone to avoid rebound
Tension HA - classification?
infrequent (14days/mo)
Tension vs MHA?
same sx EXCEPT NO photophobia and N&V
Diagnostic cluster headaches?
trigeminal autonomic response - weeping
