1. Acetaminophen 2. Aspirin 3. NSAIDs 4. Opioid ( limited use )-CI: rebound ha 5.Sumatriptan“triptans” (Serotonin agonist ) 6. Droperidol 7.Quiet / Dark room 8. Metoclopramide (Reglan) (dopamine interaction )

headache Flashcards by Elizabeth DeGroot

how many visits/yr

13 million visits annually

Brill usually starts with tylenol or ibuprofen

How well did you know this?

Not at all

Perfectly

what percentage of ER visits

serious?

How well did you know this?

Not at all

Perfectly

pathophys: Irritation of pain-sensitive intracranial structures

Large arteries
Venous sinuses
Trigeminal nerve (5th cranial nerve)

How well did you know this?

Not at all

Perfectly

pain-insensitive structures

Choroid plexus
Brain parenchyma
Ventricles ( ependymal lining )
( attributing to little or no headache mass lesions

How well did you know this?

Not at all

Perfectly

painful stimuli arising from brain tissue above the tentorium cerebelli are conveyed by the

trigeminal nerve

How well did you know this?

Not at all

Perfectly

primary

Tension-band like
Cluster-in/or around one eye
Migraine-28 million americans
sinus: behind brows

How well did you know this?

Not at all

Perfectly

secondary

Stroke
Trauma
Brain lesion
Cocaine
Sinus Disease

How well did you know this?

Not at all

Perfectly

migraine ha

Episodic Headache
Associated with 
Gastrointestinal changes*
Neurologic*
Autonomic* 
Unilateral*

One of the three is necessary for the diagnosis ? + 1 phobia

Pulsating; Unilateral
Frontotemporal

How well did you know this?

Not at all

Perfectly

migraine sn

Phono-phobia Sound sensitivity
Osmo-phobia Odor sensitivity
Photo-phobia* Light sensitivity

How well did you know this?

Not at all

Perfectly

migraine timing

May begin in childhood- don’t give dx till 5 or 8
Peak ages adolescence and
Young adulthood
Greater in woman then men

How well did you know this?

Not at all

Perfectly

aura

focal neurologic symptoms precede, accompany, follow(rarely) ha
-develops over 5-20 min
visual disturb.*
-language, sensorimotor, brainstem disturbance

How well did you know this?

Not at all

Perfectly

migraine classes

Migraine With aura
Migraine without aura
Hemiplegic Migraine
Confusional Migraine
Ophthalmoplegic Migraine 
Basilar Migraine

How well did you know this?

Not at all

Perfectly

complicated migraines usually have..

Major neurologic dysfunction
( hemiplegia and coma )
admit*

How well did you know this?

Not at all

Perfectly

basilar migraines usually…

Primarily in children 
Episodic headache
Signs of .....
Brainstem dysfunction 
Cerebellar dysfunction  
(Dysarthria, diplopia, ataxia)

How well did you know this?

Not at all

Perfectly

aura ddx

Seizure

Transient ischemic attack

How well did you know this?

Not at all

Perfectly

cluster ha

Intense steady and unilateral
Temporal location (trigeminal cephalgia)  Associated with 
Nasal congestion
Conjunctival injection 
Ipsilateral forehead sweating 
Men > Women 
Late in life onset
Rarely in childhood
Attacks often awaken patients 
“Alarm-clock headache” 
Periods of frequent headaches are separated by headache-free periods of varying duration

How well did you know this?

Not at all

Perfectly

tension ha

Most common ( primary )
Pressure feeling
Not unilateral 
Frontal / occipital 
“Pain in the neck”
Pain last for days

band-like

How well did you know this?

Not at all

Perfectly

Pseudotumor cerebri

IC hypertension
Worse with straining
Diplopia
Papilledema
Abducens palsy

How well did you know this?

Not at all

Perfectly

Pseudotumor cerebri

Thrombosis of transverse or sagittal sinus venous thrombosis
Chronic pulmonary disease
SLE
Uremia
Endocrine disorders
Drugs (tetracycline, vitamin A, OCP)
Idiopathic (most common): overweight women age 20-44

How well did you know this?

Not at all

Perfectly

imaging

Ct brain without contrast to look for space occupying lesion
MRI
MRV

How well did you know this?

Not at all

Perfectly

this confirms increased intracranial pressure

LP with opening pressure

How well did you know this?

Not at all

Perfectly

tx:

Acetazolamide
Topiramate
Prednisone
Weight loss
LP
Shunt
Optic nerve fenestration
Stop causative agent

How well did you know this?

Not at all

Perfectly

migraine tx:

Study These Flashcards

Acetaminophen
Aspirin
NSAIDs
Opioid ( limited use )-CI: rebound ha
5.Sumatriptan“triptans” (Serotonin agonist )
Droperidol
7.Quiet / Dark room
Metoclopramide (Reglan)
(dopamine interaction )

tension tx

Study These Flashcards

same + OMM

muscle relaxers: valium, diazepam

cluster tx

1. Oxygen 2. Dihydroergotamine 3. Sumatriptan (Serotonin agonist )

secondary

SAH meningitis mass lesions intraparenchymal hemorrhage

SAH

``` 1 in 10,000 headaches in the United States 1 percent of non traumatic headaches Normal findings *Thunder clap* “ Worst headache of life” Onset with exertion may have neck pain ```

mass lesion

70 % of tumors have “headache” as the initial presenting complaint -look for brain metastasis

meningitis

``` Viral / Bacterial infection Fever Nuchal rigidity Kernig’s sign ( knee extension ) Brudzinski’s sign ( leg lift ) ```

Intraparenchymal Hemorrhage

50 % of patients with IPH tumors have “headache” as the initial presenting complaint

Critical secondary causes requiring emergent identification and treatment

1. Subarachnoid hemorrhage- need MRI, look for aneurysm 2. Meningitis-start abx 3. Brain tumors-increased ICP start steroids if not resectables

Critical secondary causes not requiring emergent treatment

Brain tumor (without increase in ICP)

Generally benign and reversible secondary causes

Sinusitis Hypertension Post-lumbar puncture headache

Primary headache

Migraine Tension Cluster

how to tx LP puncture ha

typ. tx (NSAIDs, tylenol) then caffeine then anesthesia: "blood patch" over LP site, dec. CSF leakage better when lie flat

Ha eval

``` pattern (worst?) onset (SAH) location assoc. meds comorb ```

assoc. symps

Visual changes Fever Seizure Neck stiffness

meds that may cause ha

nitro | coumadin

comorbiditis

AIDS-fungal mening., cryptococcal Malignancies Coagulopathy-IC hem

Physical Exam red flags

``` Abnormal vitals Neurological exam Fundoscopic exam Kernig sign Brudzinski sign Temporal artery tenderness (scalp giant cell arteritis, bruits ```

prior hx of ha does not rule out... | and if tx and gets better, does not rule out...

serious pathology same! could still be SAH

ha preventiaon

``` topamax, topiramate? valproic acid (seizure, mood stab, trig. neuralgia) candesartan propanolol timolol verapamil amitriptyline (antidep) botulinum toxin A butterbur-herb ```

ppx for ha that..

Headaches that occur more then two or three times a month Significant disability with attacks Alteration of central neurotransmission

ha ppx

``` Valproic acid Propranolol Timolol Verapamil Amitriptyline Botulinum toxin A Acupuncture ```

CT scan for.... | before LP

``` Worst headache of life Abrupt onset Neurologic deficits Persistent vomiting Fever Trauma Loss of consciousness Altered mental status Sinus imaging ``` HIV >50 w. normal neuro exam if abnormal ???

get MRI/MRA with

Posterior fossa lesion (cerebellar issues) SAH unable to perform Lumbar puncture Venous thrombosis persistent neuro deficit with tx

ha management

Identify the correct diagnosis of headache Diminish pain associated with an acute attack Prevent pain / associated symptoms of recurrent headaches

ha diary

- ID triggers - monitor frequency - involves pt - Record response to treatment

signs that suggest pathology

``` Fever Nuchal rigidity Reflex asymmetry Altered mental status Papilledema ```

symptoms that suggest pathology

``` Worst headache of life Age over 50 Progressive Awakens patient-every morning, doesn't go away: mass Neurologic dysfunction ```

ddx ha

ocular: glaucoma environmental: high altitude metabolic: hypoglycemia toxicology: CO poisoning (cherry red macula, can measure on ABG) vascular: HTN

special pops for has

preggos: preeclampsia-->eclampsia: seizure immcomp: cryptococcal (HIV) kids: Dental infection Sinus infection Neoplasm Febrile illness

read pages 954-958

in current

``` floaters aura photophob norm exam lay in dark with cold rag ```

UCG repeat triptan dose rest, darkness

sev. pain around left eye | tearing, congestion

cluster

sev. pressure-like | worse when bending down, stren activity

papilladema CT, LP pseudotumor cerebri

headache Flashcards

(56 cards)