Flashcards in Headaches Deck (89)
What structures are sensing the pain of a headache?
meninges, blood vessels, muscles
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
migraine, tension, cluster
unchanging HA x 6 months
What is most common primary headache? Least common?
Neuro exam and imaging of primary headaches
classically unilateral (60%); can be global or bifrontal (30%)
Cluster HA location
strictly unilateral (orbit or temple)
Time course of tension HA
episodic, waxes and wanes
Characteristics of tension HA?
bilateral, "band-like tightness/pressure", pain at back of head/upper neck
Etiology of tension headache?
sustained pericardial muscle contraction
abnormal endothelial function, CNS pathway disruption??
Tension headache treatment
Lifestyle changes: stress, sleep, exercise
Treat co-morbidities (depression, migraine)
If chronic (+2/week, lasting +4 hrs) then Nortriptyline, Amitripyline, biofeedback
Time course of migraine headaches?
Builds over 10-45 min, peaks at 2 hrs, resolves in 4-72 hrs
sxs of migraine that occur 24-48 hrs before headache
sxs of migraine that occur min to hrs before
Etiology of migraines
NEUROGENIC (cortical spreading of depolarization)
Histamine, serotonin, substance P, trigeminal nerve, etc.
Common epidemiology of migraines
F > M
80% first migraine < 30 yo
When would you consider getting MRI/CT for migraines?
consider if HA changes, new onset at > 40 yo
Abortive tx of migraines
(taken at prodrome/aura)
APAP, ASA, NSAID
Acute tx of severe migraines
BB, CCB, TCA, SSRI, anti-seizure, diet changes
Associated sx of migraine
N/V, photophobia, phonophobia, visual aura
Associated sx of cluster headache
ipsilateral tearing, eye redness, stuffy nose, sweating
Associated sx of tension headache
Timing of cluster headaches
episodic clusters with long inactive phases
peaks in minutes
lasts 30-180 min (avg 1 hour)
What increases risk of cluster headaches?
Characteristic of cluster headache pain
deep, excruciating, explosive in quality
patient restless and prefers to be active with HA
Abortive tx of cluster HA
inhalation of oxygen (x 15 min)
Prophylactic tx of cluster HA
Varapamil, Prednisone, Lithium, Indomethacin
What if cluster HA is chronic and unresponsive to meds?
complete/partial section of CN V (trigeminal)