2.9 CLIN - Headache Scheme Wrap-up Flashcards
A pt. presents to your clinic with dizziness and infrequent numbness in limbs, no headache! What are you NOT going to rule out?
Brain tumor.
Cannot rule out brain tumor due to lack of headache.
What is a primary headache vs. secondary headache?
Primary = intrinsic to the brain, WITHOUT any underlying structural, infectious toxic/ metabolic cause/ psychiatric cause.
Secondary = due to something outside the brain.
How do you classify a headache as a migraine? (what 2 things give you the pointer to migraine?).
Headache + aura.
What are the three types of migraines and their classifications? (hint: classic vs. common vs….).
Common: -aura, +headache
Classic: +aura, +headache
Aura only: +aura, -headache
Name a few non-migraine primary headaches, describe a little about the ones we learned about.
Tension type headaches.
Cluster headache: retrooccular, come in clusters, want to move around, super painful.
Thunderclap headache: out of the blue, BOOOM! headache on, miserable pain, need to rule out stroke.
Benign cough headaches.
Valsavla induced (sexual, excertion).
4 stages of migraine, name them, more info in first week flashcards.
Prodrome, aura, headache, postdrome.
What is the mechanism pathway for migraine headaches (think pain)?
Event trigger -> CSD -> Trigeminal N. activation -> meningeal irritation (CGRP release, inflammation, vasodilation) => PAIN.
What neurotransmitter is depleted in migraine pts.?
Serotonin.
Treat some migraines with antidepressives, don’t know why it works but maybe because of this.
List a few things that can trigger secondary headaches.
Cranial or cervical vascular disorder.
Non-vascular intracranial disorder.
Substance or its withdrawl.
Infection.
Psychiatric.
Sinuses, nose, teeth, ears, mouth pain.
55yr old presents with inflammation of the linings of blood vessels, especially superficial temporal artery (STA).
Presentation: H/As, tenderness/ distention of STA, jaw pain/ claudication, sometimes blurred vision.
What are you going to order right away, what is this, why don’t you want to fluff this off and misdiagnose?
Giant Cell Arteritis.
Get ESR on any 50+yr old with new onset headaches.
If misdiagnosed, can lead to blindness, aortic aneurysm, stroke.
Why is an intracerebral hematoma more likely to have an associated H/A than a brain tumor?
Blood could leak out and irritate meninges.
Pt. was having intercourse, upon climax they get severe headache and grab back of neck in pain. When they present they have severe nuchal rigidity. Diagnosis?
Subarachnoid hemmorhage.
Pt. presents with acute onset H/A of occipital/ nuchal region. Some stiffness and irritation when neck is flexed. What must you order, what are you looking to rule out?
Order Ct brain or MRI, sometimes lumbar puncture (look for blood in CSF, may not always happen).
Need to rule out subarachnoid hemorrhage, or aneurysm.
Pt. presents: confusion, fever, chills, severe headache, fatigue, neck stiffness, nuchal rigidity/ pain.
What are you going to get done, how fast, what are you suspecting?
Get spinal tap to rule out meningitis, ASAP!
Pt.: young, obese, female of childbearing age with menstraul irregularities.
Symptoms: h/a, blurred vision, nausea, neck or upperback pain.
Exam: fundoscopic exam reveals papilledema.
What are you suspecting with the papilledema + symptoms?
What do you order?
What do you do when what you order is negative?
Suspect tumor.
Order scan.
Negative scan = pseudotumor cerebri.
Tell patient to lose weight and manage their pain.
