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CPD 1 > Headaches > Flashcards

Headaches Flashcards

1
Q

3 most common primary headaches

A
  1. Migraine 2. Cluster 3. Tension headache
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2
Q

Closed head injury severity based on 2 findings

A
  1. Presence/absence of LOC

2. Presence/absence of neurological signs

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3
Q

Mild TBI

A
  1. None - brief LOC, dilated pupils, flaccid mm. slowed hr
  2. Recovery in seconds-minutes
  3. Days to weeks of giddiness, anxiety, headaches, poor concentration
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4
Q

Moderate TBI

A
  1. S/S: Unconscious up to an hour
  2. Slower recovery of behavior & orientation
  3. Lethargic 1-7 days, agitation, anxiety
  4. CT scan normal or show signs of contusion
  5. Tx: hospitalization & rest
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5
Q

Severe TBI

A

Categorized by pt response vs injury

Tx: Hospitalization required

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6
Q

TBI severity grading scale

A
  1. Grade I: confusion, sx last 15min, no LOC

3. Grade III: LOC seconds-minutes

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7
Q

TBI Red Flag Symptoms

A
  1. unconsciousness
  2. altered mental status
  3. convulsions
  4. extremity weakness
  5. bleeding from ear
  6. persistent HA
  7. loss of hearing
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8
Q

Post concussion syndrome

A

sx persist for years

HA, fatigue, dizziness, memory/attention problems, sleep disturbances

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9
Q

Classifications of headaches

A
  1. primary or secondary

2. vascular or non-vascular

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10
Q

Secondary headaches (examples)

A

Caused by underlying medical condition
head/neck trauma, infection, substance use/withdrawals, psychiatric conditions, crania neuralgia (trigeminal & glossopharyngeal), etc.

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11
Q

Vascular Headache

A

Quality of pain: throbbing or pounding
Various triggers lead to change in artery size
triggers (migraine, cluster, fever, HTN, hangover, exertion)

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12
Q

Non-vascular headache

A

Quality of pain: Steady, dull, aching

tension type, ear ache, TMJ, sinus infection

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13
Q

History taking w/ c/o of headache

A 
L- location
M- mechanism
N- new
O - onset
P - provocation/palliation
Q - quality
R - Radiation
S - Severity
T - timing
Concomitants
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14
Q

Red Flags on history

A 
Onset after age 50
Increase in severity & frequency
Sudden onset
pain moves to lower neck & thoracic
First or worst headache
H/o of head trauma, HIV, CA
Any changes in mental status, personality, level of consciousness
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15
Q

Physical exam for headache

A

Vitals
Cervical ROM, carotid & temporal a. pulsation
Oral & ear exam
Tenderness of mm of head & neck
Palpate cranium, jaw, sinuses
neurological exam
HEENT exam (fundoscopic exam important to check for papilledema)

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16
Q

Red flags on Physical Exam

A 
Fever
Neck stiffness/rigidity
Papilledema
Focal neurological signs
Signs of systemic illness or infection
17
Q

Migraine - Epidemiology

A

Frequency: 2nd most common
Sex: F:M 3:1
Age: 1st incidence in childhood, increases in adolescence

18
Q

Migraine - Triggers

A 
Stress
Female hormones
hypoglycemia
loss of sleep
change in weather conditions
exercise
food intolerance
tyramine-containing foods
19
Q

Migraine - Classifications

A
  1. Migraine with aura

2. Migraine without aura

20
Q

Migraine without aura

A

Diagnostic Criteria: (at least 5 attacks with the following)
1. HA lasting 4-72hrs
2. 2 of the following
Unilateral location
pulsating quality
mod-severe pain
worse with routine activity
3. During headache at least 1 of following occurs
nausea/vomiting
photophobia and phonophobia (fear of loud noises)

21
Q

Migraine with aura

A 
May be prodromal symptoms prior then diagnostic criteria (at least 2)
       Visual
        Sensory
        Dysphasic
aura develops 5-20min last
22
Q

Screening test for migraine

A

> 90% accuracy at detecting migraine

  1. Has a headache limited your daily activity for a day or more within the last 3 mo.?
  2. Are you nauseated or sick to your stomach when you have a headache?
  3. Does light bother you when you have a headache?
23
Q

Tension type headache - epidemiology

A

Sex: F:M 2:1
Age: all ages, mostly young adults
Triggers: stress & mental tension

24
Q

Tension type - Classifications

A
  1. Infrequent episodic - episode less than 1 day a mo.
  2. Frequent episodic - episode 1-14 days a mo.
  3. chronic - headaches 15 or more days a mo.
25
Q

Tension type - Diagnostic

A

At least 2 of the following

  1. location of pain is bilateral
  2. Quality of pain is steady non throbbing
  3. Intensity mild - mod
  4. HA pain not aggravated by physical activity
26
Q

Cluster Headaches - epidemiology

A

Frequency: males .4-1%
Mortality: suicides
Genetics: possible autosomal dominant gene
Sex: M:F 4.3:1
Age: middle age ~30
Triggers: Season (spring/autumn) & smokers

CPD 1 (4 decks)

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