3- Headaches Flashcards
What are the most common types of benign HAs?
Migraine- most common dx
Cluster- most debilitating
Tension- most frequent
Migraine and cluster are what types of HA?
Vascular
A tension HA is what type of HA?
Muscle contraction
Organic diseases of the head such as an IC mass lead to what type of HA?
Traction
Meningitis of giant cell arteritis lead to what type of HAs?
Inflammatory
What is the most important factor in establishing a HA dx?
HA hx
What are common HA triggers? (6)
Diet, hormones, sensory stimuli, stress, environment, change in habits
Pt presents with a throbbing and pulsating HA on only one side of their head. Associated sxs include photophobia, phonophobia, incapacity, N/V. Movement worsens sxs. What type of HA are you concerned about?
Migraine
Pt presents with a throbbing, pulsatile, unilateral HA that lasts 4-72 hours and began without warning. What type of HA are you concerned for?
Migraine without aura (“common”)
(more frequent form)
What are the 4 phases of a migraine with aura (“classic”)?
Prodrome, aura, HA, postdrome
In a pt with “classic” migraines (with aura), when does the prodrome phase occur?
(food cravings, mood change, uncontrollable yawning, fluid retention, constipation, neck stiffness)
24-48 hrs prior to HA
Positive and negative sxs (vision, sensory, language) are a/w with phase/ type of migraine?
positive: visual/ auditory/ sensory/ motor
negative: loss of function/ vision/ hearing/ sensation/ motor
Aura phase of “classic” migraine (w/ aura)
(usually occusr 10-60 prior to HA)
How might a pt present if they are in the postdrome phase of a “classic” (w/ aura) migraine HA?
Confused, exhausted
Pt presents with abn pain response from normal ADL (combing hair, wearing glasses, etc). What condition are you concerned about?
Cutaneous allodynia
(can be a/w migraine)
Although not typically necessary for migraine dx, what is the recommended imaging study and when is it indicated? (6 indications)
CT
- “Worst HA of my life”
- Changes in presentation
- Neuro sxs
- Refractory to tx
- New onset > 50 yo
- Hx of CA or HIV
Pt presents with rapid onset HA with max intensity w/i a few minutes and lasting up to 24 hours. On PE you note additional/ multiple neuro deficits. What are you concerned for?
TIA
(vs aura = gradual onset, duration no longer than 1 hr)
Acute migraines should be treated early. What is first line pharmacologic tx (if indicated) for mild- mod?
Oral NSAIDS +/- antiemetic
Acute migraines should be treated early. What is first line pharmacologic tx (if indicated) for mod- severe?
Triptans and ergots
Pt treated for a migraine experiences chest pressure/ heaviness, flushing, weakness, drowsiness, dizziness, malaise, feeling of warmth, and paresthesia. What were they likely treated with and what pt edu should you provide?
Triptans (“tripton sensation”)
Resolves in 30 min
What are the c/i’s to triptans and ergots in the tx of HAs?
Uncontrolled HTN, pregnancy, hx of vascular disease
(pregnancy = NO ERGOTS = absolute c/i)
What meds are recommended for preventative migraine management? (4)
Propranolol
Amitriptyline
Topiramate
CGRP antagonists (migraine clinics, newly approved)
Pt presents with non-throbbing, mild-mod intensity HA with bilateral pressure and band-like. Pt states is lasts 30 min- 7 days. They DENY phonophobia, photophobia, aura, or N/V. What type of HA are you concerned for?
Tension-type HAs (TTH)- most common type of HA
Stress, jaw clenching, missed meals, depression, too little sleep, or head/ neck strain are all possible triggers for what type of HA?
Tension-type HAs (TTH)
How do you differentiate between an episodic infrequent vs episodic frequent tension-type HA (TTH)?
Infrequent: < 12 days/ yr + lasting < 1 day/month
Frequent: 1-14 days/ month + lasting 30 min- several days
Neither type is disabling