18- HA

Question 1

migraines last for

Answer 1

Last from 4-72 hours.

Question 2

how many migraine episodes needed for diagnosis

Answer 2

5

Question 3

tensions headaches last for

Answer 3

Last from 30 minutes to 7 days.

Question 4

how many tension HA episodes needed for diagnosis

Answer 4

10

Question 5

cluster HA associated symptoms

Answer 5

Associated with rhinorrhea, lacrimation, facial sweating, miosis, eyelid edema, conjunctival injection, and ptosis.

Question 6

cluster headaches last for

Answer 6

Last 15-180 minutes.

Question 7

how many cluster HA episodes needed for diagnosis

Answer 7

5

Question 8

signs of meningitis

Answer 8

Headache with fever, mental status changes, or stiff neck.

Question 9

signs of intracranial hemorrhage

Answer 9

Sudden onset of headache, severe headache, recent trauma, elevated blood pressure.

Question 10

signs of brain tumor

Answer 10

Cognitive impairment, weight loss or other systemic symptoms, abnormal neurologic examination

Question 11

signs of TBI

Answer 11

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.

Question 12

Headache due to depression or anxiety

Answer 12

Similar to tension-type headache:
Bilateral, pressing, and/or tight
Last from 30 minutes to seven days

Question 13

Medication overuse headache

Answer 13

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.

Question 14

diagnostic criteria for Medication overuse headache

Answer 14

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.

Question 15

Indications for Brain Imaging in the Evaluation of Headache

Answer 15

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

Question 16

Symptoms that increase the odds of positive neuroimaging results include:

Answer 16

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

Question 17

Kernig’s sign

Answer 17

severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees.

sign of meningitis

Question 18

Brudzinski’s sign

Answer 18

Severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed.

sign of meningitis

Question 19

caffeine and HAs

Answer 19

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.

Question 20

environmental triggers for tension HA and migraines

Answer 20

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

Question 21

Medications or substances that act as triggers:

Answer 21

Estrogen (birth control/hormone replacement)
Tobacco, caffeine or alcohol
Aspartame and phenylalanine (from diet soda)

Question 22

triptans side effects

Answer 22

Dizziness, sleepiness, nausea, fatigue, paresthesia, throat tightness/closure, chest pressure.

Question 23

triptans contra

Answer 23

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

Question 24

ergot alkaloids side effects

Answer 24

Severe reactions possible. MI, ventricular tachyarrhythmias, stroke, hypertension, nausea, vomiting, diarrhea, dry mouth, rash.

Question 25

ergot alkaloids contra

Answer 25

Concurrent use of triptans, many possibly serious drug interactions; heart disease or angina, hypertension, peripheral vascular disease, pregnancy, renal insufficiency, breastfeeding.

Question 26

when should Opioid and butalbital treatment for migraine be used

Answer 26

last resort- those with medical conditions precluding the use of migraine-specific treatments or for those who fail these treatments.

Question 27

meds for Migraine prophylaxis

Answer 27

beta blockers
TCAs- good for tension type and fibromyalgia
neurostabilizers- valproate, topiramate
herbal butterbur

Question 28

When to Initiate Prevention of Migraines

Answer 28

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.

Question 29

are tension HAs aggravated by physical activity

Answer 29

not typically