Flashcards in Neurology IV Deck (34):
primary and secondary
lifestyle causes of secondary headache disorders:
lack of exercise
Common causes of secondary headache disorder:
Most common type of primary headache in adults:
sxs of tension-type headaches:
occipital, frontal, or both
mild to moderate, occasionally severe
usually precipitated by stress or hunger
muscle tenderness (although muscle relaxants are not helpful)
tension-type headache tx:
OTC pain medications
opiates not indicated
tension-type treatment prophylactic tx:
warm or cool packs
SNRIs and anticonvulsants
A cluster headache is:
repeated episodes of excruciatingly severe, unilateral headache lasting 15 minutes to 3 hours
cluster headaches may recur:
1-8 times per day for a week to several months, then go into remission for weeks, months, or years
sxs of cluster headaches:
*severe unilateral pain accompanied by ipsilateral ptosis, miosis, conjunctival injection, lacrimation, and rhinorrhea.
*Some patients experience facial flushing, edema, or diaphoresis
*Attacks often awaken pt from sleep
Cluster headache triggers:
EtOH use and nitrates.
PET scans of individuals who are suffering from a cluster headache attack reveal:
increased metabolic activity in the hypothalamus
cluster headache tx:
*OTC pain meds and opioids are not effective.
*100% O2 in a high-flow non-rebreather mask may be helpful
*Triptans are usually helpful
*Melatonin, lithium, and anticonvulsants (TPM, VPA, GBP) may be useful
*Low dose LSD and psilocybin may be helpful
characteristics of those who are likely to suffer from cluster headaches
Men > women (5:1)
blue or hazel eyes
rugged, "lionized" facial features
onset usually 20-50 yrs
recurrent episodes of moderate to severe headache with autonomic sxs. typically unilateral, throbbing pressure-type pain lasting 1 hour to 3 days
Migraine more common in males or females?
migraines are more common in males before puberty and then shifts during adolescents.
Autonomic sxs of migraine
pallor, sunken eyes
Stages of migraine:
prodrome (hours to days before)
aura (immediately preceding)
postdrome (hours to days after)
irritability, change in mood (depression/euphoria), craving for certain foods, neck pain, constipation/diarrhea, sensitivity to smell or noise
numbness, tingling, pins-&-needles
lingering ache in the area where headache was
feeling weak or depressed
some feel euphoric
Direct cause of migraine pain?
most likely vasodilation
cause of migraine aura?
most likely caused by spreading cortical depression or vasospasm
diagnosed by history
types of migraines:
migraine with aura (classic migraine)
migraine without aura (common migraine)
chronic migraine/converted migraine
Childhood periodic syndromes
cyclic vomiting syndrome
Abdominal migraine characterized by?
abdominal pain, with or without headache
cyclic vomiting syndrome characterized by?
bouts of severe nausea and vomiting that last for hours to days, alternating with sx-free intervals.
preventative lifestyle changes fro migraines:
hydration, nutrition, sleep hygiene and sufficient hours of sleep, aerobic exercise, robust stress management
Noted migraine triggers to avoid:
MSG, nitrites, aspartame, aged cheese (tyramine), fluorescent lighting, EtOH (especially red wine), caffeine
preventative therapies for migraines:
beta-blockers, Ca2+, ACE inhibitors, tricyclic antidepressants, SNRIs, anticonvulsants (VPA/TPM), repetitive transcranial magnetic stimulation (rTMS), high doses of B2, Magnesium supplements, CoQ-10 can reduce frequency, and progesterone based contraception can be helpful in some women
Acute migraine therapies:
APAP, NSAIDs, triptans, ergot, antiemetic meds, sedating antihistamines. Opiates not indicated.