PT 2 - Neuro - Headache

Question 1

Headaches are classified into …. 2 classes

Answer 1

Primary
Secondary

Question 2

What are primary headaches?

Answer 2

Not caused by disease

Tension
Migraine
Cluster

Question 3

What are secondary headaches?

Answer 3

Caused by another condition

example:
sinus infection
neck injury
brain tumor

Question 4

What are functional headaches?

Answer 4

migraines
tension-type headaches

Question 5

What are non-functional headaches?

Answer 5

cluster headaches

Question 6

Another name for tension-type headache?

Answer 6

stress headache

Question 7

Tension-type headaches are characterized by:

Answer 7

bilateral location and pressing/tightening quality

Question 8

What are the areas of tension-type headache?

Answer 8

occipital or frontal

Question 9

Episodic tension-type headaches last:

Answer 9

intermittent - occasion
< 15 days

Question 10

Chronic tension-type headaches last:

Answer 10

> 15 days

Question 11

Tension-type headaches patho:

Answer 11

similar to migraines

cerebral arterial vasodilation

often evolve form episodic to chronic when not getting preventative measures

Question 12

Tension-type headache

Is increased frequency associated with increased intensity??

Answer 12

no -

Increased frequency NOT associated with increased intensity

Question 13

What are the clinical manifestations of Tension-Type headaches?

Answer 13

1. bilateral frontal/occipital headache as a constant, dull pressure or band-like headache

neck pain
increased tone in cervical and neck muscles

photophobia
phonophobia

no warning
no N/V

Question 14

Tension-Type Headaches:

Diagnostic Studies

Answer 14

history
clinical manifestations
symptom report

increased resistance to passive movement of head

Tenderness of head and neck

Question 15

Which headaches are:

one-sided
bilateral

Answer 15

one-sided = migraine, cluster

bilateral = tension

Question 16

Describe migraine pain

Answer 16

Unilateral throbbing pain

warning symptoms - prodomal symptoms

Question 17

Migraine:

Onset ages

Answer 17

25-55 years old

Question 18

Two categories of Migraines

Answer 18

Simple (common migraine) without AURA

Complex (classic migraine) with aura

Question 19

Aura happens –

Answer 19

closer to onset of migraine

Question 20

Type of aura -

Answer 20

visual
sensory
motor

Question 21

Risk factors of Migraines:

Answer 21

family history
Age
Female
Obesity
Low level education
Depression
Stress

w/aura
w/o aura

Question 22

Migraines

etiology - patho

Answer 22

hyperexcitable neurons in cerebral cortex
cerebral arterial vasodilation

genetic factors

Question 23

Migraines:

Clinical Manifestations

Answer 23

Prodromal symptoms -
sensory, sleep, mood, cognitive changes

Aura -
visual changes
sensory/motor phenomena - (SUE - SWAY)
physically weaker, loss of coordination - mimics stroke

Throbbing, Unilateral Pain

Throbbing matches pulse

Movement sensitive
N/V

Question 24

Migraines:

Diagnostic Studies:

Answer 24

History - symptoms

No specific lab or radiologic tests

neuroimaging not done - unless neuro exam is abnormal

Question 25

Cluster Headache: What is the inset of age?

Answer 25

20-50 years

Question 26

What is the most severe primary headache?

Answer 26

Cluster Headache

Question 27

Cluster Headache: Who are more affected? Men or women?

Answer 27

men

Question 28

Cluster Headache: Patho:

Answer 28

sudden release of histamine or serotonin dysfunction of hypothalamic

Question 29

What are common triggers of cluster headaches?

Answer 29

alcohol strong odors

Question 30

Common triggers of migraines?

Answer 30

Bright/flashing lights stress anxiety menstrual cycle sleep loss foods - tyramines, nitrites

Question 31

Cluster Headache: Clinical manifestations:

Answer 31

1. sharp, stabbing, intense pain that lasts minutes to 3 hours 2. may occur every other day up to 8 times per day 3. lasts 2 weeks to 3 months - then remission 4. severe - unilateral, NON-THROBBING headache (around the eyes) 5. swelling eye 6. nasal congestion or runny noise 7. pallor 8. tearing of eye

Question 32

Cluster Headache: Diagnsotics

Answer 32

1. Patient history 2. Symptoms

Question 33

Tension-Type Headache Drug therapy - symptomatic

Answer 33

Aspirin Acetaminophen NSAID or combo with: caffeine sedative muscle relaxant

Question 34

Tension-Type Headache Drug Therapy - Preventative

Answer 34

Anti-depressants Antiseizures Sumatriptan Ergotamine

Question 35

Migraine Headaches: Drug therapy: Symptomatic - mild to moderate headache

Answer 35

NSAID Aspirin Caffeine-containing analgesics

Question 36

Migraine Headaches: Drug therapy: moderate to severe headaches First line therapy

Answer 36

Triptans sumatriptan Vasoconstriction

Question 37

Migraine Headaches: Preventative

Answer 37

Antiseizure drugs - topiramate B - blockers Botox

Question 38

What is another name for Cluster headaches

Answer 38

Suicide headaches screen for depression and suicide

Question 39

Cluster Headache: Drug Therapy: Symptomatic --

Answer 39

100% oxygen 8-12 min for 10 min (non-rebreather) leads to vasoconstriction Triptans - sumatriptan Not for vascular factors - like HTN Stenosis CAD Peripheral Vascular Disease

Question 40

Cluster Headache: Drug Therapy: Preventative:

Answer 40

High dose verapamil invasive nerve blocks deep brain stimulation ablative neurosurgical

Question 41

Medication Overuse Headaches (MOH)

Answer 41

overuse of analgesics Rebound Headache: acetaminophen aspirin NSAIDS butalbital triptans ergotamine opiods

Question 42

Triptan - how long can use?

Answer 42

~ 6 months