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Clin Med IV - Geriatrics & Neuro > Headaches > Flashcards

Headaches Flashcards

(61 cards)

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1
Q

What quality descriptors may clue you into a migraine?

A

“Pulsating”
“Throbbing”
Lateral

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2
Q

What quality descriptors may clue you into a tension headache?

A

Tightness/pressure

Band-like

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3
Q

What quality descriptors may clue you into a neuritis headache?

A

Sharp

Lancinating

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4
Q

What quality descriptors may clue you into an intracranial lesion?

A

Dull or steady

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5
Q

What quality descriptors may clue you into a headache due to ophthalmologic disorder?

A

Pre-ocular pain

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6
Q

What quality descriptors may clue you into a migraine caused by neuralgia?

A

Localized division of trigeminal nerve

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7
Q

What 5 things do you need to ask a pt with a headache?

A
  • Quality
  • Intensity
  • Location
  • Onset/timing
  • Relation to biologic events
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8
Q

What do you mean when you ask a pt about the intensity of a headache?

A

Degree to which the pain incapacitates the patient and disrupts their quality of life

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9
Q

If a headache awakens the pt from sleep, what are 3 possibilities?

A
  • Meningitis
  • Subarachnoid hemorrhage
  • Cluster headache
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10
Q

Location of migraine headache

A

Unilateral

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11
Q

Migraine is associated with what sx’s?

A
  • N/V

- Sensitivity to light, sound, smells

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12
Q

Intracranial lesions in posterior fossa would lead to headache in what region?

A

Occipitonuchal region, lateral if one-sided lesion

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13
Q

Supratentorial lesions would lead to headache in what region?

A

Frontotemporal or approximate site of lesion

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14
Q

Onset of subarachnoid hemorrhage

A

Abrupt onset, with maximum severity in sec. or min.

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15
Q

What “thunderclap headaches” may mimic SAH?

A
  • Cerebral venous thrombosis

- Vasospasm syndromes

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16
Q

What headaches may last minutes to hours?

A
  • Migraines
  • Cluster headache
  • Intracranial tumor
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17
Q

What headache usually occurs at the same time each day/night?

A

Cluster headache

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18
Q

What headaches tend to be worse with awakening?

A

Intracranial mass

Sleep apnea

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19
Q

Which headaches tend to have more gradual onset, over several hours or days?

A
  • Meningitis

- Tension headache

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20
Q

What headaches tend to be worse at the end of the day?

A

Tension headache

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21
Q

Pharyngeal cooling is more common in what type of headache pts?

A

Migrainers

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22
Q

What might you suspect in a pt with intense headache after inactivity (e.g. sleep), where the neck is initially stiff/painful?

A

C-spine disease

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23
Q

Describe sinusitis headache

A
  • Face ache
  • Midfrontal/maxillary tenderness
  • Clock-like regularity
  • Worsens by stopping/changes in atmospheric pressure
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24
Q

Describe bursting headache

A

Initiated by alcohol, intense exercise, stooping, straining

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25
What headache occurs hours to days after intense activity/stress? i.e. "weekend"/"letdown"
Migraine
26
Allodynia is common in what headache?
Migraine (but could be GCA)
27
Most common type of primary headache
Tension headache
28
Presentation of tension headaches
- NO photophobia, phonophobia, N/V but can worsen with stress/noise/glare - Band-like tightness/pressure - Worse at end of day
29
What should also be on your differential if you are considering tension h/a in an elderly pt?
GCA
30
What findings would make you more suspicious of GCA than tension h/a in elderly pt?
- Elevated ESR (>65) - Transient visual loss/changes - Jaw claudication
31
Dx tension headache
- At least 10 episodes but <180/yr or <15/mo - Lasts 30min to 7 days - At least 2: •Pressing/tightening but not pulsating quality •Mild to moderate intensity (nonprohibitive) •Bilateral •No aggravation from normal ADLs - NO N/V - NO photo/phonophobia or just one
32
Dx chronic tension-type headache
≤ 15 days/month for at least 6 months
33
Tx tension headache
- Treat comorbid anxiety or depression - Behavioral therapy - Relaxation training - Massage
34
Most common presenting headache
Migraine
35
Presentation of migraine
- Triggered by environmental or physical stimuli | - Many pts experience aura
36
2 types of migraines
- Migraine with aura | - Migraine without aura
37
Dx migraine with aura
- 5+ attacks that last 4-72 hrs - At least 2: •Unilateral •Pulsating •Moderate-severe (interferes with ADLs) •Aggravated by stairs - During headache, at least 1: •Nausea and/or vomiting •Photo and phonophobia
38
Dx migraine with aura
2+ attacks with at least 3 w/ no underlying disorder - Fully reversible aura sx's - Aura developing gradually >4 min. or 2+ in succession - Aura doesn't last >60 min - H/A <60 min. after aura
39
Tx migraine
- During acute attacks, rest in dark/quiet room + simple analgesic - Triptans (may be better with naproxen) - Cafergot - Prochlorperazine - Metoclopramide (Reglan) - Butalbital-containing analgesics
40
What dosage forms do triptans come in?
SC PO Intranasal
41
Common side effects of triptans
Nausea, vomiting
42
AVOID triptans in these pts (5). Why?
Triptans cause vasoconstriction, esp. in cranial vessels - Hemiplegic - Basilar artery migraine - Uncontrolled HTN - Risk factors for stroke - Coronary or peripheral vascular disease
43
Dosage forms of cafergot
IV or suppository
44
Avoid cafergot in these pts
- Pregnancy - CVD - CYP3A4 inhibitors (supratherapeutic)
45
Caution with butalbital-containing analgesics. Why?
Habit forming | Rebound h/a
46
When is preventative therapy indicated for migraines?
>2-3/month
47
Preventative therapy for migraines
- Avoid ppt factors (homeostatic imbalances) - Diary to identify triggers - Rx ppx with triptans - Botulism toxin - Acupuncture - Neurostimulation
48
Presentation of cluster headaches
- Unilateral - Lasts 1-2 hrs - Associated ipsilateral autonomic signs (tearing, miosis, ptosis, rhinorrhea) - Deep, usually retro-orbital nonfluctuating pain - NO focal neuro signs - Daily at same time***
49
Dx cluster headaches
- 5+ attacks - At least every other day - Severe unilateral periorbital and/or temporal pain, last 15-180 min. untreated - At least 1, ipsilateral to pain side: •Lacrimation •Nasal congestion •Rhinorrhea •Forehead/facial sweating •Miosis •Ptosis •Eyelid edema
50
Tx cluster headache
- SC or intranasal sumatriptan (PO ineffective) - 100% O2 via non-rebreather - Zolmitriptan nasal spray - Dihydroergotamine IM or IV - Viscous lidocaine intranasal
51
Ppx for cluster headache
- Lithium carbonate - Verapamil (monitor PR interval) - Topiramate
52
Dx post-traumatic headache
- 1 day to 1 week after injury | - Can be accompanied by N/V, scintillating scotomas
53
Presentation of intracranial mass lesions
Headaches worsen when supine, awaken at night, peak in AM
54
When should you be concerned about a headache (i.e. needs further investigation)?
- New or worsening in mid-life (need CT) | - Signs of cerebral dysfunction or increased ICP
55
What neurologic conditions can cause headache?
- Cerebrovascular disease - Internal carotid artery occlusion - Carotid dissection - S/p carotid endarectomy - SAH - Meningitis - S/p LP
56
When to refer headache pt for urgent evaluation (5-ish)
- Thunderclap onset - Refractory to simple measures - Trauma, HTN, fever, visual changes - Neuro signs - Scalp tenderness
57
Presentation of psuedotumor cerebri
- Diffuse headache - Papilledema - CSF >250mm H2O - Sx's of increased ICP - No localizing sx's - Nonspecific or normal imaging
58
Imaging for pseudotumor cerebri
CT to differentiate from space-occupying intracerebral mass - CT will be normal or nonspecific
59
Tx pseudotumor cerebri
- Repetitive LPs - Acetazolamide - Thiazide diuretics - Corticosteroid for visual complaints - Surgery: lumbar-peritoneal shunting, optic nerve sheath decompression
60
Population most at risk for psuedotumor cerebri
Obese women, esp. in 20s
61
Tx post-herpetic neuralgia
- Anticonvulsants (carbamazepine, oxcarbazepine) - Gabapentin - Antispasmodic agents alone or w/ anticonvulsant - Botox injection - Surgery (microvascular decompression) - Brain stereotactic radiosurgery - Glycerol injection - Balloon compression

Clin Med IV - Geriatrics & Neuro (2 decks)

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