Compare primary and secondary headaches in terms of total percentage of headaches, periodicity, pathology, and presence of red flag symptoms.
Primary: 90% of headaches, Recurrent, No underlying pathology, No red flag symptoms. Secondary: 10% of headaches, Constant, Underlying intracranial or systemic pathology, Red flag symptoms may be present.
What are the five Red Flag Symptoms to look for in headaches?
SNOOP!! Systemic symptoms (Fever, weight loss), neurologic symptoms (Confussion, Altered LOC), onset (Sudden, abrupt), older (>50yr, GCA), previous headache history (Change in freq, intensity…)
What are the criteria for diagnosing migraines?
1 - at least 5 episodes; 2 - 4-72 hour duration; 3 - At least 2 (Unilateral, pulsating, mod-severe, inc w/ physical activity); 4 - At least 1 (Vomiting, nausea, photo or photophobia); 5 - Exclusion of other possibilities
What are the criteria for diagnosing an aura?
1 - At least 2 episodes; 2 - Reversible symptom of visual, sensory, language, motor, brainstem, or retina; 3 - 1 or more: homonymous visual field, unilateral sensory change, gradual onset >5min, duration 5 - 60 min.
What are the criteria for diagnosing tension-type headaches?
1 - 10 episodes; 2 - 30min - 7day duration; 3 - 2 or more: pressing/tightening, mild-mod intensity, bilateral, not aggravated by phys. act. 4 - no nausea/vomiting 5 - possible photo/phonophobia
What are the criteria for diagnosing cluster headaches?
1 - 5 episodes; 2 - severe, unilateral periorbital or temporal; 3 - 15-180min duration; 4 - Freq: every other day to 8x/day; 5 - 1 of: conjunctival injection, lacrimation, nasal congestion, rhinorrhea, eyelid edema, ptosis, myosis, facial swelling, ear fullness, agitation/restless
What are the signs and symptoms of meningitis?
Headache, fever, stiff neck, nausea/vomiting, altered consciousness, Kernig/Brudzinski signs (pain with bending spine)
What are the signs, symptoms, and common causes of subarachnoid hemorrhage?
Sudden, incapacitating headache, stiff neck, photophobia, N/V, altered consciousness/obtundation; Signs: starfish pattern on CT/MRI; Causes: Trauma, ruptured aneurysm, arteriovenous malformation
What are the signs and symptoms of Giant Cell Arteritis?
Headache in older (>50yo) population; Associated with: Jaw claudication, temporal artery tenderness, vision loss, joint pain, Constitutional symptoms (fever, malaise, weight loss)
What are the signs and symptoms of elevated ICP?
Exertional headache, retrobulbar pain, N/V, pulsatile intracranial noises, transient visual obscurations, Photopsia, diplopia, vision loss; Signs: Papilledema (loss of definition of veins in eye)
What is abortive treatment for migraine headaches?
Aspirin, NSAIDs, Combination NSAIDs/Caffeine/Aspirin, Triptans, Ergotamine derivatives
What is preventive treatment for migraine headaches?
B-Blockers, CCB, Tricyclic antidepressants, Anti-epileptics; Sleep, Botox injections for chronic migraine only, B2, Magnesium, Butterbur
What is abortive treatment for tension-type headaches?
Aspirin, Acetaminophen, NSAIDs
What is preventive treatment for tension-type headaches?
Tricyclic antidepressants, SSRIs, Physical therapy, psychotherapy
What is abortive treatment for cluster headaches?
Oxygen, triptan injections, Ergots
What is transitional and preventive treatment for cluster headaches?
Transitional: Steroids, nerve blocks; Preventive: CCB, lithium, Antiepileptics