Headaches Flashcards
When a patient presents with a headache, what type of history questions do you need to ask?
Location, onset, frequency, duration, quality, severity, timing, aggravating/alleviating, associated sxs (worse with…)
If a patient can’t answer a lot of those history questions, what would it be important to ask them to do?
Keep a headache diary
What type of PE would you do for a patient with HA?
BP, examine the head, vision, visual fields, EOM’s, funduscopic, neuro exam, gait, motor & reflexes
Migraines most frequently occur in what population?
Women
Does everyone with a migraine have an aura?
No, only 15% have an aura
What is the typical onset of migraines?
Initiate in adolescents/early adulthood (peaks 30-45; and regresses after age 60)
What are typical migraine triggers?
Physical activity (including sex), emotional stress, lack of sleep, foods, odors, missed meals, and menstruation
What is the main physiologic theory behind migraine headaches?
Neurogenic Theory – involving inflammatory & vascular components
the brain activates or sensitizes the trigeminal nerve → initiating a HA via neurologic inflammation.
The vascular changes that occur are a results of vascular inflammation
Physiologically, how does serotonin contribute to migraines?
A neurotransmitter that activates pain fibers and then contributes to vasoconstriction and inflammation
What is an aura?
15-30 minute episodes of focal neurological dysfunction that appear before the HA
How does an aura present?
Expanding scotoma (blind spot) with scintillating margins (stars, sparks, zigzags of light); visual field deficits, unilateral paresthesias, numbness, weakness, dysphagia
Are vertigo, ataxia, tinnitus, and hearing loss associated with an aura?
NO
What if a patient has a prolonged aura with neurological defects for an hour or more?
Then we are concerned about a complex migraine
If a patient has a complex migraine what must we rule out?
a stroke
What does the headache phase of a migraine involve?
Throbbing or pulsatile pain that can be lateralized or generalized that can last 4-72 hours
What are the associated symptoms of migraines?
N/V, photophobia, phonophobia, and anorexia
What are the rules of therapy for migraines?
Treat early, treat aggressively until HA is gone (may need more than one dose of meds), consider pros vs cons of oral meds
What is the main type of med we use for migraines?
triptans
How do tiptans work?
They have a high affinity for serotonin receptors in the trigeminal nerve branches to cause vasoconstriction
Why should a serotonin agonist abort a migraine?
Because it functions at the presynaptic autoreceptors whose activation inhibits the release of serotonin
How would we treat a mild to moderate migraine?
Oral triptan
If it’s an acute severe migraine, how would we treat it?
Consider alternative route = injection or intra-nasal
If the migraine is severe and intractable, and the patient is now at the hospital, what do we do?
Inject Demerol + anti-emetic
Would morphine help a migraine patient?
NO! it will make it worse (since it’s a vasodilator)
