Flashcards in Headaches Deck (25):
Remember to review all the serious types of headaches - too many to do cards for them all.
look at notes
Intracranial Hypertension causing headaches
idiopathic headaches due to increased ICP - usually presents with papilledema in young, overweight women with polycystic ovarian disease.
Giant cell arteritis (temporal arteritis)
systemic vasculitis w/ affinity for cranial vessels - can lead to stroke. Steroids can reverse the disease.
What are the exclusion criteria for a dangerous headache?
1. no hx of serious headache or neck injury, seizures or focal neuro symptoms or infections
2. pt afebrile
3. diastolic BP <120
4. normal fundi
5. supple neck
6. no cranial bruits
7. normal neuro exam and LOC
8. normal CBC, ESR, cranial imaging, x-rays
episodic, severe, unilateral, throbbing headaches that may present with exercise intolerance, anorexia, N/V, photophobia, &/or phonophobia. Lasts hrs-days. Usually presents in childhood or adolescence.
present with some migraines, the aura presents with a visual, somatosensory, olfactory or language changes with positive and negative symptoms that slowly comes on over 10-60 mins.
Familial hemiplegic migraine
migraines characterized by early onset and family history. There are 3 known mutations, and it is thought that these people have a lower threshold for cortical spreading depression.
Tx for migraine
medications during the headache
What meds are available for acute relief of migraines?
2. antiinflammatory meds
3. activators of serotonin receptors - Ergotamine & Triptans (decrease CGRP and substance P release)
What meds are available for prophylaxis in migraine tx?
2. Ca channel blockers
3. heterocyclic antidepressants
uncommon, but very severe HA that presents with unilateral orbital, supraorbital and/or temporal pain lasting 15 mins-3hrs. Often associated with other findings on same side of face (ptosis, lacrimation, miosis, nasal congestions, eyelid edema, conjunctival injection)
Tension Type HA
HA presenting with mild cervical or bifrontal pain when person is stressed. It is due to increased muscle activity. Muscles relaxants often relieve the headache. high risk for analgesic rebound HA
Medication Overuse Headache
HA occurring on > 15 days/mo in a pt with a pre-existing HA disorder w/ regular overuse of meds for > 3 mo. HA return to usual within 2 mo once meds are stopped.
What 4 things can "dizzy" mean?
4. other (floating type of sensation or something else)
damage to the inner ear or vestibulocochlear nerve that often produces abnormal eye movements (nystagmus), hearing loss or tinnitis, and nausea or motion sickness.
damage to the brainstem (vestibular nuclei and vestibulocerebellum) that presents with dizziness or spinning and often produces a nystagmus that may be in multiple directions or vertical. Often presents with other central nervous system findings.
Paroxysmal positional vertigo
peripheral vertigo provoked by movement. it is the most common type and generally considered benign. Seen after head trauma and in the elderly. Starts after bending over, looking up, or rolling over. Lasts 15-60 secs.
peripheral vertigo caused by movement or sustained neck positions - it usually lasts while the position is maintained.
peripheral vertigo provoked by noise. This is caused by increased pressure in the endolymph. can last 30 mins - few hrs. Overtime may cause tinnitus.
peripheral vertigo provoked by noise (changes in pressure) that is due to a leak between the inner and middle ear.
cause of central vertigo where the lower portion of the cerebellum protrudes through the foramen magnum and compressed the caudal brainstem.
Causes of central vertigo
1. cerebrovascular disease (TIA)
2. multiple sclerosis
3. Chiari malformation
5. damage to the caudal brainstem or vestibulocerebellum
results from diffuse cortical ischemia - cardiac causes are the most worrisome, though vaso-vagal events are the most common cause
Caused by disturbance of sensory and motor systems for upright posture. Usually it is the result of a multisensory deficit (inner ear, eyes, and feet proprioceptors keep you standing).