headaches Flashcards
(63 cards)
1
Q
List the two types of primary headaches (occur independently)
A
- vascular
- muscle contraction -> tension type
2
Q
List the two types of vascular headaches
A
- migraine
- cluster
3
Q
List the two types of secondary headaches (associated with another disorder)
A
- traction
- organic diseases of the head (ex: intracranial mass)
- inflammatory
- ex: meningitis
4
Q
what is the most important factor in establishing a diagnosis for headache
A
headache history
- frequency
- duration
- intensity
- location
- quality
- time and setting of onset
- aggravating/alleviating factors
- age of onset
- associated sx
5
Q
clinical presentation
- throbbing, pulsating, typicall unilateral
- duration: 4-72 hours
- +/- photophobia, phonophobia, N/V
- movement makes it worse
A
Migraine
6
Q
List the two main types of Migraines
A
- migraine without aura (“common”)
- migraine with aura (“classic”)
7
Q
what type of migraine is this
- visual aura, vertigo, dysarthria, ataxia, decreased level of consciousness, syncope, tinnitus, hypacusis (hearing impairment)
A
migraine with brainstem aura (“Basilar”)
8
Q
what type of migraine is this
- visual loss or disturbance in one eye
A
- retinal migraine
9
Q
what type of migraine is this
- unilateral HA with oculomotor palsy
- diplopia, ptosis, dilated pupil
A
- ophthalmoplegic neuropathy
10
Q
what type of migraine is this
- hx of episodic vertigo with hx of migraines
A
vestibular migraine
11
Q
what type of migraine is associated with menstrual cycle
A
menstrual migraine
12
Q
what type of migraine is this
- temporary paralysis
- familial component
A
hemiplegic migraine
13
Q
what type of migraine is this
- rare, severe disabling migraine lasting > 72 hours
- requires hospitalization
A
status migrainosus
14
Q
how long does an aura last both before the HA comes on and total time
A
- visual and/or other neurological sx 10-60 min prior to HA
- aura last less than 60 min
15
Q
What is the premonitory symptoms phase of migraine
A
- 24-48 hours prior to HA
- food craving, mood change, uncontrollable yawning, fluid retention, inc urination, neck stiffness
16
Q
what are the positive symtoms of an aura
A
- visual
- auditory
- sensory
- motor
17
Q
what are the negative symtoms of an aura
A
- loss of function, vision, hearing, sensation, or motor
18
Q
what is characteristic about the onset of a migraine
A
builds gradually in intensity
19
Q
postdrome phase of migraine may be associated with
A
- confusion
- exhaustion
20
Q
describe the sensory aura associated with a migraine
A
- unilateral tingling (face, limb)
- abnormal sensations
21
Q
define cutaneous allodynia
A
- abnormal pain response from things like combing hair, shaving, wearing glasses, contact lens, earrings, tight fitting clothing
22
Q
how are migraines diagnosed
A
- history and physical exam
- no imaging necessary
23
Q
what are clinical scenarios involving HA that warrant imaging
A
- “worst headache of my life”
- changes in HA presentation
- new or unexplained neurologic symptoms
- HA not responding to treatment
- new onset after 50 or in pts with CA or HIV
24
Q
what imaging is recommended in evaluation of HA
A
CT
25
acute migraine tx
* decrease triggers
* rest in dark quiet environment
* cool cloths on forehead
* fluid
* caffeine in early stages
* meds
26
first line medications/abortive for mild/moderate migraine
* oral NSAIDs, acetaminophen or OTC combination (excedrin, midrin)
* N/V -\> add antiemetic
27
first line medications/abortive for moderate/severe migraine
* **triptans** and Ergots
* ****oral triptans or combination with NSAID (sumatriptan, naproxen)
28
side effects of Triptans
* "Tripton sensation"
* chest pressure, weakness, dizziness, paresthesia
* resolve in 30 min
29
contraindications to Triptans and Ergotamine
* these meds are vasoconstrictors
* uncontrolled HTN
* pregnancy
* Hx of MI, Cerebrovascular disease, peripheral vascular disease
30
List the three medications that are first-line for preventative migraine management
* propranolol (B-blocker)
* amitriptyline (TCA)
* Topiramate (anticonvulsant)
\*consider co-morbidies when choosing
31
clinical presentation
* bilateral pressure, band-like
* mild-moderate intensity
* duration 30 min-7 days
* anorexia, head/neck pain with muscle tenderness, bruxism (grinding teeth)
* no N/V
tension type headache
32
list common triggers for tension type headache
* stress
* jaw clenching
* missed meals
* depression
* too little sleep
* head/neck strain
33
criteria for infrequent episodic tension type headache
* \< 12 days/ year
* lasting \< 1 day/month
34
criteria for frequent episodic tension type headache
* 10-14 days/month
* lasting 30 min to several days
35
criteria for chronic tension type headache
* \> 15 d/month
* lasts hours to days
* may be unremitting
36
how are tension type HA diagnosed
* history and clinical presentation
37
treatment for tension type HA
* NSAIDs
* high initial dose
38
cluster headaches are commonly seen more in what patient population
Men
39
cluster headaches are associated with what
* **Trigeminal autonomic cephalgias** (TACs): sharp, boring, **unilateral,** **periorbital** HA with **autonomic** sx
40
duration of cluster headaches
* brief, 15-180 minutes
41
how often can cluster headaches come on
* attacks: every other day - 8x/day
* clusters: typicallly 6-12 weeks
42
remission period for cluster HA
up to 12+ months
43
chronic cluster headache
* clusters lasting \> 1 year or remission \< 1 month
44
are cluster headaches associated with a certain time of day
* come on similar time of day/night
45
autonomic sx of cluster headache
* **parasympathetic hyperactivity and sympathetic impairment**
* lacrimation
* eyelid edema
* nasal congestion
* rhinorrhea
* facial sweating
* miosis
* ptosis
* \*\*\***ipsilateral to pain**
46
triggers commonly associated with cluster headache
* alcohol
* smoking
* stress
47
how is cluster headache diagnosed
* history and clinical presentation
* **MRI with and without contrast**
* to evaluate brain and pituitary gland
48
treatment of acute cluster headache
* **Oxygen**: nonrebreathing facemask 100% O2 at 12 L/min
* sitting upright
* continue **x 15 min**
* **triptan: subcutaneous sumatriptan**
49
preventative medication for cluster headache
* start at onset of cluster episode
* **CCB: Verapamil**
50
criteria for chronic daily headache
* \> or = **15** days/month during **3+** months
51
list four types of chronic daily headaches
* chronic migraine
* chronic tension type
* hemicrania continua
* newly daily persistent headache
52
clinical presentation
* continuous, fluctuating pain on **same side** of face/head lasting minutes-days
* associated sx: tearing, irritated eyes, rhinorrhea, swollen eyelids
hemicrania continua
53
tx of hemicrania continua
indomethacin and/or corticosteroids
54
clinical presentation
* pain ranges mild-severe: throbbing/tightening on **both sides** of head
* associated sx: light/sound sensitivity
* may occur following infection, medication use, trauma, or other condition with no previous hx or headache
newly daily persistent headache
55
clinical presentation
* "ice pick" or "jabs and jolt" headache
* pain is intense and strikes without warning
* lasts 1-10 seconds
* may occur anywhere along trigeminal nerve
* occur daily-yearly
* primary stabbing headache
56
triggers associated with primary exertional headache
* coughing, sneezing, intense activity
57
imaging recommended for primary exertional headache
* MRI/MRA to r/o vascular abnormalities
58
clinical presentation
* "alarm clock headache"
* occurs later in life (\> 50 yo)
* develops during sleep and awakens people at night
* \> 10 episodes/month lasting 15 min-3 hours
hypnic headache
59
treatment for hypnic headache
* caffeine at night \> indomethacin \> lithium
60
What is the SNOOP checklist for secondary headaches
* Systemic sx or illness (fever, weight loss)
* Neurologic (focal sx, decreased LOC)
* Onset sudden
* Older (new onset \> 50 yo)
* Previous HA hx (1st HA or change in HAs)
61
clinical presentation
* sx increase with cough, exertion, straining, position
* papilledema, vision loss, pulsatile tinnitus
* CSF pressure
* idiopathic intracranial hypertension
62
clinical presentation
* abrupt severe headache
* "thunderclap headahce"
* decreased LOC, nuchal rigidity
* first and worst HA
subarachnoid hemorrhage
63
clinical presentation
* primary HA develops or worsens with medication overuse
* typicall preceeded by an episodic HA disorder
* high risk: opioids, barbituates, aspirin, acetominophen
* HA often occurs when analgesic is withheld
medication overdose headaches
