19: Headache - Thompson

Question 1

when should a HA concern you?

Answer 1

when they are different

almost everyone in American has them at some time- the concerning aspect is when they are different

Question 2

constant, bilateral, not associated with nausea or photophobia

Answer 2

tension HA aka stress

usually has a trigger

more common in women

not muscle tension - likely serotonin chemical changes

Question 3

tx tension HA

HA likely to occur with change in sleep, stress, skipped meal, hormone fluctuation, MSG

Answer 3

avoiding triggers
Ibuprofen (any OTC NSAIDS)
tylenol
caffeine as adjunct
biofeedback/relaxing

Question 4

s/s migraine

Answer 4

throbbing
movement makes worse
moderate to severe
photophobia
sound sensitive
fatigue
n/v
visual issues
unilateral (2/3) and often switches side
triggers (hormones)

Question 5

triptans for migraine

Answer 5

zomig, imitrex, relpax, maxalt

spendy

80% effective

increase risk of CV event

don’t use in ppl with uncontrolled HTN, h/o CV disease

SE- dizzy, flushing, feel strange

NSAIDs and caffeine can be just as effective

do not give narcotics to migraine

Question 6

** prophylaxis against migraine

Answer 6

meds to prevent - consider wehn HA interfere with life, greater than 2/wk, greater than 2/month that don’t response or can’t take rescue meds

beta blockers
BCP
antidepressants
antiseizure (neurontin)

Question 7

clusters HA

Answer 7

clusters (wk or mo) of HA that can last from 3 min to hrs

pain so intense personc cna consider suicide - much more common in males

eye/nose on one side often affected (red/runny eye, runny nose)

Question 8

treat cluster HA

Answer 8

oxygen
triptans
narcotics
occipital n. stimulation

Question 9

secondary causes of HA

Answer 9

bleed
HTN
metabolic issues
caffeien or med withdrawal
tumor
brain infection
stroke
vision
illness/fever
acute sinusitis
sleep apnea

Question 10

when to worry about secondary cause?

Answer 10

age extremes (over 50 w/o clear history or cause
neuro changes
different HA
worst of life
trauma
seizures
neck/fever/exposure
PMH of cancer or HIV

Question 11

inflammation of temporal artery

Answer 11

temporal arteritis

greater than 50 yo

women more than men

new onset
pain at site or decreased pulse
biopsy of temporal a.

tx presnisone prior to biopsy to prevent permanent visula loss)

Question 12

3 types of primary HA

Answer 12

tension
migraine
cluster

secondary could be from sinus, HTN, etc…

Question 13

common treatment migraine (what Thompson uses)

Answer 13

IVF
toradol/vistaril
10 mg compazine I
25-50 mg Benadryl IV
Droperidol/ Benadryl
Imitrex

can treat 100% HA without narcotics