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MJ- F2 E4- Neuro > Headaches (primary HAs)- MJ > Flashcards

Headaches (primary HAs)- MJ Flashcards

(49 cards)

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1
Q
  • What age group are tension headaches MC in?
  • MC in men or women?
A
  • Mid teens to < 50 (uncommon > 50)
  • M >W (3:2)
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2
Q

What are the 4 risk factors of tension-type headaches?

A
  1. Stress
  2. Fatigue
  3. Noise
  4. Glare

(“Some Noise Gives Father tension headaches”)

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3
Q

The following is the proposed etiology of which type of headache?

  • Peripheral activation/sensitization of pericranial myofascial nociceptors
  • Decrease nociceptor threshold
  • Normally innocuous stimuli are misinterpreted as pain
  • Prolonged nociceptive stimuli from pericranial myofascial tissues sensitizes pain pathways in the CNS
A

Tension type headache

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4
Q

The following are clinical findings of which type of headache?

  • Daily/episodic HAs lasting from 30 minutes to 7 days
  • Bilateral
  • Pressing / tightening quality (non-pulsating)

•Mild or moderate intensity

  • Photophobia / phonophobia are rare
  • Not increase with activity

•No N/V

•May have increased tenderness of pericranial myofascial tissue

A

Tension headache

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5
Q

Does tension headache normally have N/V, photophobia and phonophobia? If not, what headache is this usually seen in?

A
  • No N/V, photophobia/phonophobia are rare
  • these are seen in migraines
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6
Q

What is acute 1st line tx for tension headaches?

A
  • NSAIDS (Ibu, Naproxen)
  • Acetaminophen
  • Aspirin

*can combine w/ caffeine for increased effect*

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7
Q

What should you NOT use for acute tx of tension headaches?

A
  • Opioids
  • Butalbital (Fiorinal,Fioricet)
  • Muscle relaxants
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8
Q

What are 5 non pharmacologic treatments for tension headaches?

A
  • Biofeedback
  • CBT
  • Relaxation techniques
  • Acupuncture
  • PT

(“PT’s eat CARBs”)

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9
Q

What is the pharmacologic treatment for chronic tension headaches (>7-9 HAs/month)

A
  • Tricyclic antidepressant (Amitriptyline or Nortriptyline)
  • May reduce frequency and intensity of attacks
  • Start with low dosage
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10
Q

What 2 other antidepressants can be used as treatment for chronic presentation of tension headaches (>7-9 HAs/month) if there is a contraindication for tricyclic antidepressants?

A

Mirtazapine

Venlafaxine

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11
Q

Which 2 anticonvulsants can be used as treatment for chronic presentation of tension headaches (>7-9 HAs/month)

A

Topiramate

Gabapentin

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12
Q

What are all of the pharmacologic treatment options for chronic presentaton of tension headaches ( >7-9 HAs/month)?

A
  • Tricyclic antidepressants (ex: Amitriptyline, Nortriptyline)
  • Other antidepressants (if tricyclic contraindicated)
    • mirtazapine
    • venlafaxine
  • Anticonvulsants
    • Topiramate
    • Gabapentin
  • Tizanidine
  • Trigger point injections- Lidocaine
  • Botox
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13
Q

Who are cluster headaches most common in? (gender, age)

A

Most common in:

  • Men
  • > 30y/o (peak in 40s)
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14
Q

Which type of headache is the least common primary headache disorder?

A

Cluster headaches

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15
Q

The following are risk factors for which type of headache?

  • Genetics (1st degree relative= 14 fold increase)
  • Cigarette smoking
  • Prior head injury
  • High alcohol consumption
  • Type A personality
A

Cluster headache

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16
Q

The following is the pathophysiology behind which type of headache?

  • Hypothalamic activation with secondary activation of the trigeminal-autonomic reflex
A

Cluster headache

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17
Q

The following are triggers of which type of headache?

  • Alcohol
  • Stress
  • Glare
  • Specific foods
  • Disorder of circadian rhythm
  • Sleep (reduced oxygenation)
  • Sildenafil
  • Volatile smells
  • Vasodilators
  • Smoking
A

Cluster headache

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18
Q

The following is the clinical presentation of which type of HA?

  • HA 15-180min up to 8x/day
  • unilateral (usually eye/temporal)
  • pain peaks w/in 10-15 min
  • Often at night (nighttime awakenings)
  • Severe, piercing, boring, exploding, penetrating
  • Individuals are agitated and restless
A

Cluster headache

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19
Q
A
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20
Q

What are the 2 forms of cluster headaches?

Study These Flashcards
A
  1. Episodic (MC)- attack phases last 2-16wks followed by cluster free period of 6mo-years
  2. Chronic- No sustained cluster free episodes >1mo
21
Q

Patients with cluster headache should have at least 1 of what 6 symptoms on the affected side?

(“My Cute Pet Louie Runs Noisily”)

Study These Flashcards
A
  1. Conjunctival injection
  2. Lacrimation
  3. Nasal congestion
  4. Rhinorrhea
  5. Ptosis
  6. Miosis

(“My Cute Pet Louie Runs Noisily”)

22
Q

What is the 1st line treatment for a patient with an acute episode of a cluster headache?

Study These Flashcards
A
  • **100% O2**
  • Sumatriptan SC (contraindicated in CVD), or intranasal zolmitritptan
23
Q

Other than 100% O2, that are the 4 other options for tx of an acute episode of cluster headache?

Study These Flashcards
A
  1. Intranasal lidocaine
  2. Oral ergotamine
  3. IV dihydroergotamine
  4. Glucocorticoids (to help bridge)
24
Q

When a patient presents with a cluster headache, you want to start treatment for the acute attack as well as preventative tx. What medication can you use to help bridge this?

Study These Flashcards
A

Glucocorticoids

25
26
T/F: Treatment for cluster headaches (like O2) is good for aborting **_individual_** attacks
TRUE
27
When is there a poor prognosis for patients with cluster headache?
•Poor prognosis if **not diagnosed and successfully treated** (reduced QoL, increased depression)
28
29
* What is the best **preventative/prophylactic treatment** for **cluster headaches**? * When is this medication **contraindicated**?
**_Verapamil_** (Contraindicated in heart block and arrhythmias)
30
Other than verapamil (most effective), what are 2 other options for **prophylactic/preventative tx** of cluster headaches?
* Greater occipital nerve block * Surgical and neurostimulation options being investigated
31
32
What is unique about a new daily persistent headache as opposed to other headaches?
Pt is able to identify exact moment in time when they first got headache
33
Are New Daily Persistent Headaches common or uncommon? What population do they affect the most (age, race, ethnicity)?
* Uncommon * All ages, races, ethnicities
34
Which type of headache is an **acute onset of a chronic headache**? (can persist x years)
New Daily Persistent Headache
35
What is the duration of a New Daily Persistent Headache?
2.5-24hrs/day
36
What are the common characteristics of a New Daily persistent Headache? * Location? * Intensity/character? * Associated sxs?
* **Bilateral** * Moderate intensity- **throbbing/pressure-like** * Assoc. sxs: **nausea, photophobia and phonophobia**
37
What is the treatment for New Daily Persistent Headaches?
Preventative tx for migraine or tension headache
38
**The following is criteria for which type of headache?** * **Distinct and clearly remembered onset**, with pain becoming **continuous and unremitting within 24 hours** * Pain may be migraine-like or tension-type-like, or have elements of both * Present for **≥ 3 months**
New Daily Persistent Headache
39
What PMHx question is important to ask when interviewing a patient with c/o headache?
* **History of headaches**? Is this similar to prior headaches? If not, what are normal headaches like? * History of CA, neuro dz, HTN, immunosupppresion
40
The following sxs are considered what? 1. **Sudden onset** (“thunderclap”)- SAH 2. **New onset** headaches **\> 50 y/o** 3. New onset or severe **headache in pregnant or post-partum** patient (eclampsia, clots) 4. **Worst or first severe** headache of life 5. **Change** in pattern/severity of chronic headaches 6. **PMHx** of CA, immunocompromised, or increased risk of coagulopathy
Red Flags
41
The following sxs are considered what? 1. **Awakening from sleep** 2. **Persistent morning HAs w/ nausea** 3. Brought on by **exertion** or with **postural changes** or **worsens with coughing, lifting, or bending** 4. **Weight loss** (malignancy) 5. Altered Mental Status 6. Fever, nuchal rigidity
Red flags
42
The following sxs are considered what? 1. Focal neuro deficits 2. Globe tenderness 3. Papilledema 4. Tender temporal artery (temporal arteritis) 5. Severe HTN
Red Flags
43
When should you order a CT/MRI for a patient with c/o headache?
If you suspect **bleed or mass** (if looking for bleed, do CT w/o contrast)
44
What is the location for Migraines vs. Tension vs. cluster headaches?
* Migraines= unilateral (majority of kids have bilateral) * Tension= bilateral * Cluster= unilateral (around eye or temple)
45
Compare the classic characteristics of migraine vs. tension vs. cluster headache?
* _Migraine:_ gradual, pulsating, moderate-severe, aggravated by routine physical activity * _Tension:_ pressure/tightness that waxes and wanes * _Cluster_: abrupt onset; reaches crescendo w/in minutes; pain is deep, continuous, excruciating and explosive
46
**Which type of primary headache?** * abrupt onset * reaches crescendo w/in minutes * pain is deep, continuous, excruciating and explosive
Cluster
47
Compare the patient appearance of someone w/ migraine vs tension vs cluster headache?
* _Migraine:_ pt wants to **rest in dark, quiet room** * _Tension:_ pt may remain **active or want to rest** * _Cluster: p_t is **restless**
48
Compare the duration of migraine vs tension vs cluster
* _Migraine:_ 4-72hrs * _Tension:_ 30min-7days * _Cluster:_ 15min-3hrs
49
Compare the associated sxs of migraine vs tension vs cluster headaches
* _Migraines:_ N/V, photophobia, phonophobia, +/- aura * _Tension:_ none * _Cluster:_ Ipsilateral lacrimation and redness of the eye, stuffy nose, rhinorrhea, pallor, sweating, horner syndrome, restlessness or agitation

MJ- F2 E4- Neuro (19 decks)

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