Headaches Flashcards
(29 cards)
Primary HA
not associated with any other disease
migraine
tension type
cluster
Secondary HA
associated with a condition that will not resolve until that conditions is treated tumor brain bleed meds such as nitrates meningitis arterities viremia
SNOOP mneumonic for HA red flags
systemic symptoms neurologic signs onset sudden onset > 50 or < 5 previous HA history
systemic symptoms for HAs
fever
wt loss
neurological signs for HA
confusion LOC altered nuchal regidity HTN papilledema cranial nerve dysfx
previous HA history for HA
onset of different HA
change in pattern or severity
sudden thunder clap HA =
subarachnoid hemorrhage
Tension type HA characteristics
30 min - 7 days pressing, nonpulsatile pain mild to mod intensity bilateral more female than male
Migraine w/o aura characteristics
4 - 72 hours pulsating mod to sev intensity aggravated by normal activity unilateral n/v photophobia phonophobia family hx more remales
Migraine with aura characteristics
focal dysfx of cerebral cortex with causes aura to develop over 4 min
may have feeling of dread or anxiety, fatigue, GI upset, visual or olfactory alteration
no aura should last > 1 hour
family hx
Cluster HA
occur daily in groups or clusters
last several weeks to months
occurs often 1 hour into sleep
located behind one eye
crescendo pattern lasting 15 min to 3 hours
ipsilateral signs ( lacrimation, conjunctival injection, ptosis and nasal stuffiness).
Treatment options for HAs
lifestyle modification analgesics rescue therapy migraine specific meds prophylactic or controller meds
lifestyle modification for HA
triggers could include chocolate, alcohol, chesses, MSG, perfumes, stress, sleep
get routine exercise
analgesics for HA
NSAIDS
tylenol
limit to 2 tx days/wk to avoid rebound HA
rescue therapy for HA
opioids, antimetics, corticosteroids
if severe and don’t respond to typical therapy
migraine specific meds for HA
Triptans
caution with pregnancy, CV disease, uncontrolled HTN
helpful with tension type HA
used in tx for cluster HA
prophylactic or controller meds for HA
beta blockers
tricyclic antidepressants ("lines")
antiepiletic drugs (gabapentin)
calproate
topiramate
lithium
butterbur
feverfew
coenzyme Q10
magnesium
riboflavinCriteria for prophylaxis in HA
use of any product more than 3 x per week
> 2 migraines per month that last > 3 days
the goal is to reduce HA frequency and severity
When to refer HA to specialist
has a dx that needs supported or clarified by specialist
fails to respond to tx
Avoid with CT if you suspect bleed
contrast
Use CT for
hemorrhage
edema
atrophy
Use MRI for
tumor AV malformations posterior fossa lesions meningitis hemorrhage of days to weeks in duration soft tissues
What kind of contraception can cause HA
combined estrogen-progestin oral contraceptives
When considering EBP for use of prophylactic migraine tx which is the preferred agent
propranolol
