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Clinical Neurology > Headaches/Migraines > Flashcards

Flashcards in Headaches/Migraines Deck (12)
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Criteria of migraine w/o aura

*5+ attacks with the following:
- headache for 4-72h
- headache as at least 2 of these things: u/l, pulsating, moderate-severe intensity, aggravated by physical activity
- N/V, photophobia, phonophobia (1)
- H&P or tests do not show another etiology


criteria of migraine w/ aura

*2+ attacks that have at least 3 of the following:
- 1 or more reversible aura
- 1+ aura symptoms develops over 4 minutes or 2+ symptoms in succession
- no aura lasting more than 1h
- headache follows aura
- H&P and test show no pathology


types/examples of auras

- aura = warning sign for a migraine
- lasts 15-30minutes and happens before, during or after head pain begins
1. visual - scintillating scotoma, fortication spectra
2. paresthesias - numbness in face/hands
3. weakness - hemiplegia on one side
4. aphasia
5. vertigo
- migraine equivalent: 1 of these happens by themselves w/o the headache


prodrome and symptoms

- premonitory phenomena preceding headache by hours to days
- symptoms include: mental and mood changes, stiff neck, chilled feeling, increased urination, anorexia, bowel changes, food cravings, fluid retention
*not the same as auras


migraine: pathophysiology

- aura phase associated w/ reduction in cerebral blood flow
- spreading of oligemia at 2-3mm/min
- oligemia progression doesn't respect vascular territories
- oligemia seen in migraines w/ and w/o aura
- phenomenon = "spreading depression"
- pain generated by sterile neurogenic inflammation
- CGRP gene release via trigeminovascular system that is activated as protective mechanism in response to oligemia


criteria for tension headache

- at least 2 of the following: pressure/tightening quality, mild-moderate intensity, b/l location, not aggravated by exertion
- no N/V, photophobia, phonophobia
- No H&P or tests find other etiology


episodic tension headache: frequency/duration

- at least 10 previous headache episodes:
- headaches last 30 minutes to 7d


chronic tension headache frequency

- average headache frequency = >15d/month for longer than 6 months
- psychosocial/psychiatric issues are more common in these pts


factors confounding dx of tension headaches

- stress triggers
- b/l or non-pulsating head pain
- presence of neck pain
*in pts w/ these symptoms you need to consider dx of migraines; find a way to r/o one or the other


cluster headache criteria

*5+ attacks fulfilling:
1. severe u/l orbital, supraorbital, and/or temporal pain lasting 15-180m untreated
2. Has 1 of the following symptoms on same side as pain: conjunctival injection, lacrimation, nasal congestion, rhinorrhea, forehead/facial sweating, miosis, ptosis, eyelid edema
3. frequency = 1 every other day to 8 per day
- No H&P or test suggest other dx


cluster headache characteristics

- onset younger than 19yo
- male predominance
- usually occurs at night, often at same time each day
- paces or pounds fist or head w/ attack
- may commit suicide


criteria for sinus headache

- considered secondary dx from acute sinusitis
- requires presence of purulent nasal discharge and pathologic sinus findings in tests including xray, CT or MRI
- chronic sinusitis is not validated as a cause of headache or facial pain unless relapsing into an acute stage