Lecture 6: Headaches Flashcards Preview

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Flashcards in Lecture 6: Headaches Deck (18)
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1
Q

Primary Headache definition

A

headache itself is the disorder, no other known problem

2
Q

Primary Headache Red Flags

A

1) New HA pattern: increase frequency, intensity
2) Known or suspected medical cndtn: immune compromise–> think CNS infxn; prior h/o malignancy –> think mets to brain
3) Morning or Cough HA: aka traction ax’s
4) Age of onset: >50 y/o be suspicious
5) Localized neuro findings: papilledema (think ICP); LOC, seizures, personality/cog changes, visual changes
6) Thunderclap HA: think SAH
7) Meningismus: HA + fever + nuchal rigidity
8) Orthostatic HA: increase HA with standing, resolves when lying down
9) Temportal HA + Jaw Claudication: think temporal arteritis

3
Q

Migraine quick facts

A
  • 18% women, 8& men
  • evidence of migraines in girls/boys equal until menses
  • fluctuates during menstrual cycle, pregnancy, completion of menopause
4
Q

Migraine without aura: ax’s and triggers

A
  • unilateral pain, peaking to throbbing over min-hrs, lasting hrs-days
  • N/V, photophobia and phonophobia
  • triggers: stress relief from acute stress, hormonal changes, bright lights/strong odors, sleep disturbances
5
Q

Migraine with aura: sx;s

A

aka classic migraine

  • visual sx’s most common: shimmering, jagged lines, blind spots, homonymous hemianopsia
  • arise in 5-10 min and lasts 20 min or longer
6
Q

Pediatric migraine

A
  • brief spells (30-120 min) of only mild HA

- but with severe abdominal pain, vomiting and vertigo

7
Q

Risk Factors of Migraine Progression

A

1) Chronic medical cndtns: can intensify underlying migraine disorder
2) meds rebound HA: caffeine, opioids, barbs, ergots, NSAIDs
3) CHronic Cervical strain: causes painful sensory activity to trigeminal nucleus (region that processes HA pain)
4) Depression/Anxiety Disorder
5) Stress management
6) Poor sleep
8) estrogen
9) tobacco
10) chronic inactivity
11) Body wt

8
Q

Cluster Headache features

A
  • much less common than migraines
  • more common in men
  • short duration reaching peak in min and lasting < 2 hrs
  • pain: unilateral/periorbital and accompanied by ipsilateral vasomotor sx (tearing, conjunctival injxn, stuffy nose, rhinorrhea)
  • may be triggered by alcohol, fall/spring
  • pacing around room, hit thmeself in area of discomfort
  • tx: high flow O2 and ejectable sumatriptan, verapamil + melatonin
9
Q

Tension-Type HA

A
  • mild, short lasting
  • most commonly during young adulthood, middle age and in females
  • pain: bilateral, aching, pressure, band-like
  • brief and mild; tx with OTC: and relaxation techniques
10
Q

Secondary HA

A

have a medical or neurological cause for HA problem; HA is sx of another cndtn
-examples: Meningitis, Intracerebral hemorrhage, subarachnoid Hemorrhage, temporal arteritis, Pseudotumor cerebri, primary cough HA, intracranial lesions

11
Q

Meningitis

A
  • acute onset, severe, constant, photophobia, phonophobia, seizure
  • PE: fever, meningismus, altered mental status
  • Labs: leukocytosis,
  • Tx: 3rd gen ccephalosporin, vancomycin, ampicillin, acyclovir, antifungals
12
Q

Types of meningitis

A

1) bacterial: neissaria, pneumococcus, H.flu, listeria
2) Viral: HSV, echovirus, mumps, arbovirus
3) fungal: cryptococcus, histoplasma, candida

13
Q

Intracerebral Hemorrhage

A
  • acute onset, variable, N/V
  • on PE: HTN, focal deficit, variable meningismus, lethargy
  • location of hemorrhage important clue as to underlying cause
  • tx: correct coagulopathy control BP, may need to evacuate or embolize
14
Q

Causes of intracerebral hemorrhage

A
  • HTN
  • Coagulopathy
  • amyloid angiopathy
  • vascular malformation
  • trauma
  • drug abuse
15
Q

Temporal arteritis

A
  • age over 50,
  • jaw claudication
  • vision loss
  • dx: ESR > 80, temporal artery bx
  • Tx: steroids, presumptive therapy
16
Q

Pseudotumor Cerebri

A
  • increased ICP for no obvious reasons
  • sx’s: mod-severe HA, worsen with eye mvmnt, blurred vision, diplopia, tinnitus
  • PE: papilledema and enlarge blind spots
  • DX: LP- CSF is normal, increased ICP
  • Tx: Acetazolamide: decreases CSF production; wt loss or lumbar peritoneal shunt (if meds don’t work)
17
Q

Primary Cough HA

A
  • severe headache pain with coughing, only lasts few min
  • self limited
  • indomethacin may provide relief
18
Q

Intracranial Lesions

A
  • cause HA due to displacement of vascular structures,

- HAs are nonspecific and may vary in severity