Headaches Flashcards
What are the primary types of headaches in adults?
migraine, tension, cluster, and chronic daily
What are the characteristics of migraine headaches?
usually unilateral; gradual onset; aggrevated by activity; duration: 4-72 hours; accompanied by aura; throbbing/pulsatile; accompanied by nausea, vomiting, photophobia, phonophobia; triggered by stress, menstruation, visual stimuli, weather changes, nitrates, fasting, wine, sleep disturbance, aspartame
What are the characteristics of tension headaches?
mild to moderate pain, bilateral, nonthrobbing (pressure or tightness that waxes/wanes), duration: 30 minutes to 7 days
What are the characteristics of cluster headaches?
always unilateral; severe pain; rapid onset; pain is deep and explosive; orbital/supraorbital/temporal; last 15-180 minutes; accompanied by ptosis, lacrimation, miosis, conjunctival injection, rhinorrhea, nasal congestion; patient remains active
What are some misperceptions about causes of headaches?
sinusitis, eye strain, hypertension can cause headache (rarely do)
What should be included in the history for a headache?
age at onset, presence of aura/prodrome, frequency, duration, intensity, number of headache days per month, time/mode of onset, quality of pain, associated symptoms, family Hx, precipitating/relieving factors, triggers, environmental factors
What physical parameters should be assessed in patients with headache?
BP, pulse, bruit, palpation of head/neck/shoulders, check arteries, spine/neck muscles
What should be included in the neurologic exam of patients with headache?
mental status, CN exam, funduscopy, otoscopy, symmetry of reflexes, gait, walking on tiptoes/heels, tandem gait, Romberg
What are the reg flags in headache assessment (SNOOP)?
Systemic symptoms (fever, weight loss, cancer)
Neurologic symptoms (confusion, impaired consciousness, papiledema)
Onset is new or sudden (thunderclap)
Other associated conditions/features (head trauma, drug use)
Previous headache history with progression or change - assess with MRI (preferred) or CT
What headache symptoms suggest a specific etiology?
impaired vision/halos (glaucoma), visual field defect (lesion of optic pathway), sudden/severe/unilateral vision loss (optic neuritis), blurred vision with forward bending (increase ICP), nausea/vomiting/worse with change in body position (tumor), intermittent headaches with high BP (pheochromocytoma)
What should women who experience migraine with aura do to reduce risk for stroke?
stop smoking, control BP, use method of birth control other than contraception with estrogen
What are the primary symptoms of an aneurysmal subarachnoid hemorrhage?
sudden, severe headache (worst headache of my life) - may or may not be accompanied by loss of consciousness, nausea, vomiting, and meningismus (nuchal rigidity, photophobia, headache)
How is subarachnoid headache (SAH) diagnosed?
noncontrast head CT scan (highest sensitivity 6-12 hours after SAH) - follow-up with lumbar puncture if CT is negative and SAH suspected
What are the classic signs of SAH with a lumbar puncture?
elevated opening pressure, elevated RBC count that does not diminish from CSF tube one to tube four, xanthochromia (pink or yellow) - indicates that blood has been in the CSF at least 2 hours
What are the common causes of subdural hematoma?
traumatic head injury, cerebral atrophy, chronic alcohol abuse, use of antithrombotic agents
