18- HA Flashcards
migraines last for
Last from 4-72 hours.
how many migraine episodes needed for diagnosis
5
tensions headaches last for
Last from 30 minutes to 7 days.
how many tension HA episodes needed for diagnosis
10
cluster HA associated symptoms
Associated with rhinorrhea, lacrimation, facial sweating, miosis, eyelid edema, conjunctival injection, and ptosis.
cluster headaches last for
Last 15-180 minutes.
how many cluster HA episodes needed for diagnosis
5
signs of meningitis
Headache with fever, mental status changes, or stiff neck.
signs of intracranial hemorrhage
Sudden onset of headache, severe headache, recent trauma, elevated blood pressure.
signs of brain tumor
Cognitive impairment, weight loss or other systemic symptoms, abnormal neurologic examination
signs of TBI
Head injury with subsequent confusion and amnesia. Loss of consciousness sometimes occurs. Subsequent headache, dizziness, and nausea and vomiting. Over hours and days: mood and cognitive disturbances, sensitivity to light and noise, and sleep disturbances.
Headache due to depression or anxiety
Similar to tension-type headache:
Bilateral, pressing, and/or tight
Last from 30 minutes to seven days
Medication overuse headache
Mild to moderate in severity
Diffuse, bilateral headaches that occur almost daily and are often present on first waking up in the morning.
Often aggravated by mild physical or mental exertion.
Can be associated with restlessness, nausea, forgetfulness, and depression.
diagnostic criteria for Medication overuse headache
More than 15 headaches per month.
Regular overuse of an analgesic for more than three months.
Development or worsening of a headache during medication overuse.
Headache resolves or reverts to its previous pattern within 2 months after discontinuation of overused medication.
Indications for Brain Imaging in the Evaluation of Headache
The patient has migraine with atypical headache patterns or unexplained abnormalities on neurological examination
The patient is at higher risk of a significant abnormality
The results of the study would alter the management of the headache
Symptoms that increase the odds of positive neuroimaging results include:
Rapidly increasing frequency of headache
Abrupt onset of severe headache
Marked change in headache pattern
A history of poor coordination, focal neurologic signs or symptoms, and a headache that awakens the patient from sleep.
A headache that is worsened with use of Valsalva’s maneuver
Persistent headache following head trauma
New onset of headache in a person age 35 or over
History of cancer or HIV
Kernig’s sign
severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees.
sign of meningitis
Brudzinski’s sign
Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed.
sign of meningitis
caffeine and HAs
Caffeine can help headaches but an excess can make them worse, especially when coming off of it abruptly. Slowly decrease the use of diet sodas. The caffeine worsens both migraines and tension-type headaches, but coming off of caffeine too quickly may make things worse in the short term.
environmental triggers for tension HA and migraines
Intense or strenuous exercise Sleep disturbance Menses Ovulation Pregnancy (though for many women, headaches actually improve during pregnancy) Acute illness Fasting Bright or flickering lights Emotional stress
Medications or substances that act as triggers:
Estrogen (birth control/hormone replacement)
Tobacco, caffeine or alcohol
Aspartame and phenylalanine (from diet soda)
triptans side effects
Dizziness, sleepiness, nausea, fatigue, paresthesia, throat tightness/closure, chest pressure.
triptans contra
Concurrent use of ergotamine, MAOIs; history of hemiplegic or basilar migraine; significant cardiovascular, cerebrovascular, or peripheral vascular disease; severe hypertension; pregnancy; in combination with SSRI’s, may cause serotonin syndrome
ergot alkaloids side effects
Severe reactions possible. MI, ventricular tachyarrhythmias, stroke, hypertension, nausea, vomiting, diarrhea, dry mouth, rash.
ergot alkaloids contra
Concurrent use of triptans, many possibly serious drug interactions; heart disease or angina, hypertension, peripheral vascular disease, pregnancy, renal insufficiency, breastfeeding.
when should Opioid and butalbital treatment for migraine be used
last resort- those with medical conditions precluding the use of migraine-specific treatments or for those who fail these treatments.
meds for Migraine prophylaxis
beta blockers
TCAs- good for tension type and fibromyalgia
neurostabilizers- valproate, topiramate
herbal butterbur
When to Initiate Prevention of Migraines
At least six headache days per month
At least four headache days with at least some impairment
At least three headache days with severe impairment or requiring bed rest.
are tension HAs aggravated by physical activity
not typically
