Headache Lecture Powerpoint Flashcards
Headache epidemiology
90-95% will experience in lifetime, 90% of headaches fall into either tension, migraine, or cluster type with tension being most prevalent in population
Pain sensitive structures of head (7)
- Arteries (circle of willis, cerebral arteries, meningial arteries, veins/dural sinuses)
- Scalp
- neck muscles
- cranial nerves V, VII, IX, X
- sinus mucosa
- teeth
- skin
Primary vs secondary headaches
Primary include migraine, tension type, and cluster as well as other categories vs secondary which are caused by potentially serious underlying disease such as a space occupying mass, vascular lesion, infection, etc.
Red flags that point toward a worrisome secondary headache (6)
- Fixed neurological deficits
- extremely abrupt onset
- papilledema (increased intracranial pressure)
- New onset of headache in patients <5 or >50 years old
- signs of infection (nuchal rigidity for example)
- altered state of consciousness
Aneurysms presentation and treatment
- A secondary cause of headache that is often asymptomatic until rupture occurs, sees the ballooning out of a blood vessel with a berry appearance, if rupture sudden onset headache with severe “worst headache of life” resulting in stiff neck, fever, nausea, vomiting, with several neurological signs dependent on location of aneurysm
- need immediate treatment such as surgical clipping
Meningitis definition, presentation, and diagnosis
- Inflammation of the meninges that is a 2ndary cause of headache
- Usually presents with stiff neck, early prodromoal illness fever may be present and later focal neurological signs develop
- need CT to rule out mass then immediate lumbar puncture
Cervicogenic headache definition, diagnosis, and treatment
- 2ndary cause of headache that is from referred pain from cervical spine or neck soft tissue pathology
- best diagnosed by resolution of headache following diagnostic blockade of a cervical structure or its nerve supply
- pain resolves within 3 months after treatment of causative lesion
Idiopathic intracranial hypertension/pseudomotor cerebri presentation, diagnosis, and treatment
- Characterized by transient headache with visual loss or decrease for no apparent reason usually affecting young obese women of childbearing years, increased risk with use of estrogen and vit A
- Diagnosis made by obtaining lumbar puncture with opening pressure
- Weight loss is curative in many cases, acetazolamide (diamox) is used often alongside optic nerve sheath decompression to treat
Low pressure headache definition, presentation, and treatment
- Headache that resolves or greatly decreases in supine and returns when upright position is maintained
- very intense pain with vomiting that can be spontaneous (sometimes rarely brought on by sneeze or cough) or related to a spinal procedure such as lumbar puncture (slow leakage causing decreased pressure)
- can be treated by placing blood patch at the site of the leak to cure it completely
Temporal arteritis/giant cell arteritis definition, presentation, diagnosis, treatment, comorbidity
- Inflammation of temporal artery causing head pain close to temporal region
- associated with jaw claudication almost exclusively in patients over 60
- typically ESR is elevated, temporal artery biopsy is gold standard for diagnosis
- treat with steroids to prevent vision loss
- 50% also develop polymyalgia rheumatica
Temporal arteritis is often the first presenting condition in a patient that will develop….
…..polymyalgia rheumatica
Polymyalgia rheumatica
Inflammatory disease in patients older than 65 characterized by muscle pain and stiffness, particularly in the shoulders
Medication overuse headache definition, prevalence among men vs women, treatment (what should be delayed in using)
- Headache from frequent and regular use of any analgesic (opiod, acetaminophen, etc), a consequence of regular overuse for more than 3 months
- more common in women than men
- withdrawal of overused medication is treatment of choice while bridge therapy used during withdrawal to provide symptomatic relief, prophylactic medication used to treat suspected primary headache disorder should only be initiated after withdrawal
Sinus headache misdiagnosis, presentation
- Although commonly diagnosed by physicians and patients, acute and chronic sinusitis is an uncommon cause for recurrent headaches, many times these patients are actually having migraine headaches
- usually bilaterally pressure like or dull sensation, not usually associated with nausea vomiting or photophobia unlike migraines
Migraine epidemiology
Affects 12% of population with women>men, most common in 30-39 year old range, tends to run in families
Migraine mech of action
(proposed)
- Cortical spreading depression (self propagating wave of neuronal and glial cell depolarization across cerebral cortex)
- aura caused by this
- activation of the afferent components of trigem nerve that triggers the release of inflammatory and pain producing substances that can be significantly disabling
Migraine
Episodic disorder characterized by recurrent attacks that occur over the course of several hours or days resulting in severe headache, nausea, photophobia, phonophobia that progresses thru 4 phases typically (prodrome, aura, headache, postdrome)
Prodrome phase of migraine
Occurs in 60% of people about 24-48 hrs prior to the headache, symptoms can include euphoria, depression, irritability, food cravings, constipation, neck stiffness, and increased yawning
Aura phase of migraine
25% of patients experience gradual development of symptoms, seeing visual changes (most common) - shapes, bright lines, etc. Auditory changes such as tinnitus, hearing noises, somatosensory changes such as burning, pain, parasthesia, or motor symptoms such as jerking or repetitive movements, as well as loss of vision, hearing, feeling, or ability to move part of body often mischaracterized as stroke
