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Flashcards in Headaches Deck (89)
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1

What structures are sensing the pain of a headache?

NOT brain
meninges, blood vessels, muscles

2

Characteristics of HA to question in history

quality, site, radiation of pain, frequency, intensity, duration of attack, precipitating or relieving factors, time of onset, vision changes aura/prodrome, age of onset, days/month, recent trauma, menstrual cycle, food/etoh

3

Primary headaches

migraine, tension, cluster
unchanging HA x 6 months

4

What is most common primary headache? Least common?

Tension
Cluster

5

Neuro exam and imaging of primary headaches

Usually normal

6

Migraine location

classically unilateral (60%); can be global or bifrontal (30%)

7

Cluster HA location

strictly unilateral (orbit or temple)

8

Time course of tension HA

episodic, waxes and wanes

9

Characteristics of tension HA?

bilateral, "band-like tightness/pressure", pain at back of head/upper neck

10

Etiology of tension headache?

sustained pericardial muscle contraction

abnormal endothelial function, CNS pathway disruption??

11

Tension headache treatment

OTC NSAID/Tylenol
Lifestyle changes: stress, sleep, exercise
Treat co-morbidities (depression, migraine)

If chronic (+2/week, lasting +4 hrs) then Nortriptyline, Amitripyline, biofeedback

12

Time course of migraine headaches?

episodic, disabling
Builds over 10-45 min, peaks at 2 hrs, resolves in 4-72 hrs

13

prodrome

sxs of migraine that occur 24-48 hrs before headache

14

auras

sxs of migraine that occur min to hrs before

Visual (65%)
Sensory
Motor
Speech/language
Photophobia

15

Etiology of migraines

NEUROGENIC (cortical spreading of depolarization)

Histamine, serotonin, substance P, trigeminal nerve, etc.

16

Common epidemiology of migraines

F > M
80% first migraine < 30 yo
+FHX

17

When would you consider getting MRI/CT for migraines?

consider if HA changes, new onset at > 40 yo

18

Abortive tx of migraines

(taken at prodrome/aura)
APAP, ASA, NSAID
Benadryl
Various Triptans

19

Acute tx of severe migraines

TRIPTANS
anti-emetics (metoclopramide)

20

Migraine prophylaxis

BB, CCB, TCA, SSRI, anti-seizure, diet changes

21

Associated sx of migraine

N/V, photophobia, phonophobia, visual aura

22

Associated sx of cluster headache

ipsilateral tearing, eye redness, stuffy nose, sweating

23

Associated sx of tension headache

None

24

Timing of cluster headaches

episodic clusters with long inactive phases
sudden onset
peaks in minutes
lasts 30-180 min (avg 1 hour)

25

What increases risk of cluster headaches?

smoking

26

Characteristic of cluster headache pain

deep, excruciating, explosive in quality
patient restless and prefers to be active with HA

27

Abortive tx of cluster HA

inhalation of oxygen (x 15 min)
Triptans

28

Prophylactic tx of cluster HA

Varapamil, Prednisone, Lithium, Indomethacin

29

What if cluster HA is chronic and unresponsive to meds?

complete/partial section of CN V (trigeminal)

30

Rebound headaches

rhythmic cycle of pain and narcotic use
daily HA that varies in location & intensity
tx: taper off pain meds