Headache Flashcards
how are most headaches caused
blood flow or muscle contractions
what are some ocular causes of HA
open angle glaucoma, uveitis, scleritis, optic neuritis, RE, muscle imbalance, orbital tumor, and severe dry eyes
what are primary types of headaches
tension type, migraine, and cluster
musculoskeletal system or neurological centers
What is a tension type HA, symptoms and how was it caused; how long does it last; treatment?
78% of headaches; bilateral dull band-like tightness around head with no photophobia or phonophobia and does not worsen with physical activity
dysfunction of pain perception: persistent myofascial input causing pain and sterile inflammation – changes the pain process
caused by emotional stress, awkward working position, and depression/anxiety
W>M
4-6 hours long
Tx: OTC NSAIDs, caffeine, exercise, or stress therapy
What is a migraine? What are the symptoms? What are the associations? What are the triggers? What is the diagnosis criteria?
13-18%: unilateral pain with nausea, visual changes
Multigenic; W>M
History of car sickness, benign vertigo or correlation with depression/anxiety
Neurovascular Theory: lowered threshold to stimuli – hyperexcitability – excessive firing of neurons – cortical spreading depression – activate CN V – dura BV pain
Triggers: stress, head trauma, weather or air pressure, bright light, meds, menstrual changes, smoking, fasting, red wine, tyramine (cheese), artificial sweetener, caffeine, MSG, alcohol
Dx: 5+ attacks, 4 hours to 3 days, more than 2 of the following: unilateral, throbbing, moderate to severe pain, worsen with physical activity, or 1 of the following: nausea (80%), vomit (50%), and photophobia or phonophobia
What are the stages of a migraine
Prodrome: 1-2 days prior, constipation, diarrhea, irritable
Aura: not always, last 20 mins before
Attack: moderate to severe pain up to 3 days and associated symptoms (peripheral weakness)
Postdrome: fatigue
What is a common migraine
migraine without an aura (80%)
unilateral, throbbing pain with N, V, and photophobia, anorexia, and 25% increase in MI/stroke
conjunctival injection + tearing
Improved with sleep
What is a classic Migraine
migraine with aura (15-20%) that lasts around 20-60mins
- scintillating scotoma (bilateral developed in brain)
- initial paracentral, enlarging in 7 mins, obscure central by 15 mins, and break up by 20 mins
Dx is 2+ attacks instead of 5
2x risk of MI (W) and 2x risk of ischemic stroke
What is a retinal migraine
transient, monocular visual disturbance
vascular spasm causing an interruption in ciliary or retinal circulation
How do you manage migraines
Prophylactic Tx for >2/month or Severe
Abortive (decrease severity or duration)
Avoid triggers, OTC aren’t effective
What is a cluster headache
0.4% excruciating unilateral pain (orbital, supraorbital, temporal)
Dx around 20-40 year olds with 80% smokers and 50% heavy ETOH abuse
attacks last a week up to a month (15-180 mins)
Trigeminal pain processing changes
Nasal congestion, sweat, projectile lacrimation, conjunctival redness, miosis, ptosis, agitated/moving
Tx: verapamil, lithium, divalproex, O2 and Sumitriptan
