Headache Flashcards by Joel Glotfelty

What are the three major primary headache disorders?

Represent 80-90% of headaches
entirely diagnosed by history

Migraine, tension-type headache, and trigeminal autonomic cephalalgias

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Has the feature of being unilateral, but not side-locked with a pounding or throbbing quality

Migraine

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Three phobia features of migraines are

Photophobia, phonophobia, and osmophobia

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Migraines can have nausea with or without vomiting and typically last

4-24 hours

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Begins 5-30 minutes before migraine and typically lasts 15-30 minutes

Aura (classic presentation)

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Characterized by flashing lights/bars (scotomata) and is sometimes somatosensory

Aura

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Worsened by activity and patients prefer to sleep off the headaches in a dark, quiet room

Migraine

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Very common when there is familial history and patients with a history of motion sickness

Migraines

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What is a comorbidity of migraines?

Anxiety and depression

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Migraines can occur at any age, but prevalence increases steeply at ages

10-14 until 35-39

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Migraines are 2-3 times more common in

Women

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Incidence declines greatly in women following menopause

Migraines

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Mediates pain from cerebrovasculatureand craniofacial region

Trigeminal ganglion

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Symptoms of a migraine suggest origin in the

Brainstem, hypothalamus, cortex, or limbic system

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Cortical spreading depression

Neurobiology migraine aura

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In a migraine, behind zone of activation is zone of depression (depolarization), which correlates with the onset of

Headache

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Usually starts while flow is diminished

Headache

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Isn’t severe enough to cause ischemia

Oligemia

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What are the 4 abortive treatments of migraines?

NSAIDS, anti-emetics, Triptans/ergots, or combination

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A major pharmacologic preventative medication for migraines is

CGRP inhibitors

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Hunger, dehydration, and lack of sleep are known triggers of

Migraines

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What are two forms of migraines of higher severity?

Status migrainosus and transformed migraines

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Migraine lasting longer than 72 hours

Status migrainosus

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Migraines that move into chronic daily headaches

Transformed migraines

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Typically a bilateral pressing or tightening in quality and of mild to moderate intensity -Most common headache type

Tension headaches

Lasts minutes to days and lacks migrainous features

Tension headache

You can see increased pericranial tenderness by manual palpation with a

Tension Headache

Affects 0.5-5% of the population and is slightly more prevalent in women than men

Tensions headaches

Tension headaches are more common in those with

Depression and generalized anxiety disorder

1/4 of patients with fibromyalgia had a prior diagnosis of chronic

Tension Headaches

Characterized as cluster headaches

Trigeminal Autonomic Cephalalgias

What are the two forms of trigeminal autonomic cephalalgias

SUNCT and SUNA

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing

SUNCT

Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms

SUNA

Has autonomic features ipsilateral to the headache

Trigeminal autonomic cephalalgias

1-8 attacks per day and attacks occur in series lasting for weeks or months

Cluster headaches

Separated by remission periods usually lasting months or years -Maximal orbitally, supraorbitally, and temporally

Cluster headaches

With cluster headaches, patients have a sense of

Restlessness or agitation

Cluster headaches are more common in

Men (302) than women (20s or 60s)

Cluster headaches are different than a migraine because they have no

Prodrome or aura

Cluster headaches last

15 minutes to hours

Often awaken patients in the middle of the night and are periodic, occurring at the same time of day/same time of year

Cluster headaches

55% of patients with cluster headaches have contemplated

Suicide

With cluster headaches, we see activation in the

Ipsilateral posterior hypothalamic gray matter

Inherited cases of cluster headaches makes up about 5% of cases. The inheritance pattern is

Autosomal dominant

The autosomal dominant cluster headaches are due to mutations in the

Hypocretin receptor 2 gene (HCRTR2)

The headache often begins in sleep and is linked to sleep apnea with

Cluster headaches

Severe, strictly unilateral pain which is orbital, supraorbital, temporal, lasting 2–30 minutes and occurring several or many times a day

Paroxysmal Hemicrania

Non-stop > 3 months; incessant, sometimes severe, sidelocked headache that will only respond to indomethacin

Continua Hemicrania

Moderate or severe unilateral head pain, with orbital, supraorbital, temporal and/or other trigeminal distribution, lasting for 1–600 seconds and occurring as single stabs, series of stabs or in a sawtooth pattern

SUNCT

Attacks last 7 days to 1 year, separated by pain-free periods lasting at least 1 month

SUNA

Should be used initially to treat hemicrania

Indomethacin

What is the daily dose of indomethacin used for hemicrania?

150 mg daily but can be increased to up to 225

Indicated for the following headaches: paroxysmal hemicrania, cough-induced, ice pick (stabbing), SUNCT

Indomethacin

What are the three main types of trigeminal autonomic caphalgias?

Cluster, Paroxysmal hemicrania, and SUNCT

Commonly called the "ice pick headache" -Jabs and jolts

Primary stabbing headache

Headache attributed to external application of cold stimulus or ingestion/inhalation of a cold stimulus

Cold-Stimulus headache

It is important to focus on cranial nerve examination and fundoscopy (optic discs) for

Secondary headaches

Dull, deep, throbbing in center of head –forehead, nasal bridge, upper cheeks -often starts after a bad cold

Sinus headache

Worse with bending down or leaning over and worse in cold and damp weather

Sinus headache

Pressure-like pain behind one specific part of face, postnasal drip and red and swollen nasal passages

Sinus headache

Taking abortive medications more than twice weekly in general can cause headaches occurring more than 15 days per month. This is called a

Medication overuse headache

Regular overuse for >3 months of one or more drugs that can be taken for acute and/or symptomatic treatment of headache

Medication overuse headache

What are some of the common causes of medication overuse headaches?

Opiods, caffeine, and Triptans

Elevated/high intracranial pressure with no structural CNS abnormality and no CSF outflow obstruction

Idiopathic intracranial hypertension (Pseudotumor Cerebri)

What are three common signs we would see in a patient with Idiopathic intracranial hypertension (Pseudotumor Cerebri)

Overweight, blurred vision with papilledema, and high opening pressure in lumbar puncture

Cranial nerve VI palsy is also a common symptom of

Idiopathic intracranial hypertension (Pseudotumor Cerebri)

“Spinal headache”, “Spinal leak” after lumbar puncture (LP) -Only occurs upon sitting or standing

Low CSF pressure headache

A ruptured Tarlov cyst can cause a

Low CSF pressure headache

Downward displacement of cerebellar tonsils at least 3 mm into upper cervical canal -Common syringomyelia (syrinx) (hydromyelia) cervical > cervicothoracic

Chiari I mlformation

What are two treatments for a Chiari I malformation?

Suboccipital craniectomy, C1 ring laminectomy

Has the clinical features of occipital or upper cervical headache with Valsalva [bending over, laughing, coughing and sneezing]

Chiari I malformation

Also characterized by down-beating nystagmus

Chiari I Malformation

Neuropathic pain in the distribution of a cranial nerve -Sharp, brief, and lancinating

Cranial Neuralgias

Inflammatory arteritis of the temporal artery causing headache, monocular visual loss and jaw claudication

Temporal Arteritis

Temporal arteritis is characterized by

Increased Erythrocyte Sedimentation Rate (Greater than 100 mm/hr)

Headache Flashcards

(76 cards)