Headache

Question 1

What is the treatment for tension headaches, and how does it present

Answer 1

Presents as a vice like headache that can get worse through the day

Treatment:
Mild/moderate - NSAIDS, acetaminophen, aspirin
Severe - migraine medications

Remember that aspirin can be used for headaches

Question 2

Cluster headaches have two subtypes. What are they, and what is their prevalence

Answer 2

Episodic - 90%: Lasts 2-3 months with remissions months to years

Chronic - 10%: Lasts 1 to 2 years, headaches do not remit

Question 3

What are the clinical symptoms of cluster headaches

Answer 3

UNILATERAL periorbital pain with ipsilateral lacrimation, facial flushing, nasal stuffiness/discharge

Usually occurs at sleep, lasts for 30 to 90 minutes and patient awakens from sleep as a result

Question 4

Cluster headaches can be made worse by something. What are those two things

Answer 4

Alcohol and sleep

Question 5

How do you acutely treat a cluster headache

Answer 5

1. ) Supatriptan (imitrex) - drug of choice

2. ) O2 inhalation

Question 6

What can be used to prophylactically treat cluster headaches

Answer 6

Verapamil daily

Question 7

What is the genetics and pathogenesis of migraine headaches

Answer 7

Autosomal dominant with incomplete penetrance

Pathogenesis: Serotonin depletion

Question 8

What are the four types of migraine headaches

Answer 8

1. ) Migraine with aura - 15%
2. ) Migraine without aura - 85%
3. ) Migraine menstrual: Due to estrogen withdrawal
4. ) Status migrainosus: lasts over 72 hours

Question 9

People who experience migraine with aura are only 15%, what is the aura

Answer 9

Happens DURING migraine attack: Could be visual (flashing lights, scotomata, visual distortions) or neurologic

Question 10

What are some things that can provoke a migraine headache

Answer 10

Menstruation, stress, anxiety, lack of sleep,

Foods: Alcohol, cheese, chocolate, smoking, OCP’s

Weather changes

Question 11

Thirty percent of patients experience a prodrome of symptoms. What are they?

Answer 11

Excitation or inhibition of the CNS

Question 12

What are some symptoms during the actual attack

Answer 12

Nausea, vomiting, photophobia, increased sensitivity to smell - 90% experience this

Question 13

What is the treatment for ACUTE attacks of migraines

Answer 13

Abortive medication

Mild: Acetaminophen, analgesics

Question 14

Sumatriptans are actually contraindicated in many situations. What are some of these situations

Answer 14

1. ) CAD
2. ) Pregnancy
3. ) HTN
4. ) Use of MAOi, SSRI, or lithium

Question 15

What is prophylaxis treatment for migraines

Answer 15

First line: Propanolol, amitriptyline (prop is better)

Second line: Verapamil, valproid acid, methylsergide

NSAIDs and estrogen therapy for menstruation migraines