Headaches Flashcards Preview

Clin Med IV - Geriatrics & Neuro > Headaches > Flashcards

Flashcards in Headaches Deck (61):
1

What quality descriptors may clue you into a migraine?

"Pulsating"
"Throbbing"
Lateral

2

What quality descriptors may clue you into a tension headache?

Tightness/pressure
Band-like

3

What quality descriptors may clue you into a neuritis headache?

Sharp
Lancinating

4

What quality descriptors may clue you into an intracranial lesion?

Dull or steady

5

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

Pre-ocular pain

6

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

Localized division of trigeminal nerve

7

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

- Quality
- Intensity
- Location
- Onset/timing
- Relation to biologic events

8

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

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

9

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

- Meningitis
- Subarachnoid hemorrhage
- Cluster headache

10

Location of migraine headache

Unilateral

11

Migraine is associated with what sx's?

- N/V
- Sensitivity to light, sound, smells

12

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

Occipitonuchal region, lateral if one-sided lesion

13

Supratentorial lesions would lead to headache in what region?

Frontotemporal or approximate site of lesion

14

Onset of subarachnoid hemorrhage

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

15

What "thunderclap headaches" may mimic SAH?

- Cerebral venous thrombosis
- Vasospasm syndromes

16

What headaches may last minutes to hours?

- Migraines
- Cluster headache
- Intracranial tumor

17

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

Cluster headache

18

What headaches tend to be worse with awakening?

Intracranial mass
Sleep apnea

19

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

- Meningitis
- Tension headache

20

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

Tension headache

21

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

Migrainers

22

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

C-spine disease

23

Describe sinusitis headache

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

24

Describe bursting headache

Initiated by alcohol, intense exercise, stooping, straining

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