10. Headache & Other Craniofacial Pains Flashcards
Ushered in by a disturbance of nervous function, most often visual, followed in a few minutes by hemicranial headache, nausea & sometimes vomiting, all of which lasts for hours or as long as a day or more
Migraine with aura/ classic or neurologic migraine
Unheralded onset over minutes or longer of hemicranial headache with or without nausea or vomiting, lasting for hours or as long as a day or more
Migraine without aura/ common migraine
A less common form of migraine syndrome with prominent brainstem symptoms
Basilar migraine
Recurrent unilateral headache associated with weakness of the extraocular muscles
Ophthalmoplegic migraine
Migraine type wherein neurologic symptoms, instead of being transitory, leave a prolonged or even permanent deficit, indicative of an ischemic stroke
Complicated migraine
Daily or virtually severe continuous headache
Status migrainosus
Treatment for migraine if headaches are mild
NSAIDs
Treatment for severe attacks of migraine headache
Triptans/ ergot alkaloids
Treatment for severely ill patients, having failed to obtain relief from prolonged headache with NSAIDs, ergots, or triptans; also used for ongoing status migrainosus
Metoclopromide 10 mg IV + dihydroergotamine 0.5 to 1 mg IV every 8 hours for 2 days
Used for refractory cases of migraine & for terminating migraine status
Corticosteroids
Most effective agents for prevention of migraine
Beta blockers
Anti-epileptics
TCAs
Characterized by consistent unilateral orbital localization with a nightly occurrence, between 1 & 2 hours after the onset of sleep
Cluster headache
Characterized by infraorbital radiation of pain, ipsilateral partial Horner syndrome, & ipsilateral hyperhydrosis; important because of high frequency of underlying intracranial lesions
Trigeminal autonomic cephalalgia
Resembles cluster headache but is of shorter duration, the paroxysms occur many times each day, recur daily for longer periods, & most important, respond dramatically to the administration of indomethacin 25-50 mg TID
Chronic paroxysmal hemicrania
Attacks are even briefer & more frequent & does not usually respond to indomethacin
SUNCT (short-lasting unilateral neuralgiform attacks with conjunctival injection & tearing)
Treatment to terminate a cycle of cluster
100% O2 via 10-15 min at the onset of headache
Verapamil
Treatment for nocturnal attacks
Ergotamine at bedtime
Most common type of headache; usually bilateral; absence of persistent throbbing quality, nausea, photophobia, phonophobia, & clear lateralization of migraine
Tension headache
The only type of headache that exhibits the peculiarity of being present throughout the day, day after day, for long periods of time
Chronic tension-type headache
Treatment of tension headache
Simple analgesics
Anti-depressants (amitriptyline)
Headache syndrome in older patients with a nocturnal occurrence; bilateral & unaccompanied by lacrimation & rhinorrhea
Hypnic headache
Steps to take at the earliest suspicion of cranial arteritis
1) immediate administration of corrticosteroids
2) biopsy
A common disorder of middle age & later life, consisting of paroxysms of intense stabbing pain in the distribution of the mandibular & maxillary divisions of the trigeminal nerve; another characteristic feature is initiation of a jab or series of jabs of pain by stimulation of certain areas of the face, lips, or gums
Trigeminal neuralgia/ tic douloureux
Treatment for trigeminal neuralgia
Carbamazepine/ anti-epileptics
