Lecture 6: Headaches Flashcards Preview

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Flashcards in Lecture 6: Headaches Deck (18):

Primary Headache definition

headache itself is the disorder, no other known problem


Primary Headache Red Flags

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


Migraine quick facts

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


Migraine without aura: ax's and triggers

-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


Migraine with aura: sx;s

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


Pediatric migraine

-brief spells (30-120 min) of only mild HA
-but with severe abdominal pain, vomiting and vertigo


Risk Factors of Migraine Progression

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


Cluster Headache features

-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


Tension-Type HA

-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


Secondary HA

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



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


Types of meningitis

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


Intracerebral Hemorrhage

-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


Causes of intracerebral hemorrhage

-amyloid angiopathy
-vascular malformation
-drug abuse


Temporal arteritis

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


Pseudotumor Cerebri

-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)


Primary Cough HA

-severe headache pain with coughing, only lasts few min
-self limited
-indomethacin may provide relief


Intracranial Lesions

-cause HA due to displacement of vascular structures,
-HAs are nonspecific and may vary in severity