9: Headache Flashcards
Status migrainosus
A debilitating migraine attack lasting for more than 72 hrs
Primary headache
Migraine Tension-type headache Cluster headache Paroxysmal hemicrania Primary cough headache Primary headache associated with sexual activity Hemicrania continua
Chronic migraine
Migraine headache occurring on 15 or more days per month for more than 3 months
Persistent aura without infarction
aura sx persist for more than 1 week without radiographic evidence of infarction
Migraine triggered seizure
One type of epileptic attack occurs during or within 1hr after a migraine aura
Childhood periodic syndrome
1: cyclic vomiting
2: abdominal migraine
3: Benign paroxysmal vertigo of childhood
Abdominal migraine
an idiopathic recurrent disorder seen mainly in children and characterized by episodic midline abdominal pain manifesting in attacks lasting 1-72hrs with normally btw episodes. At least 5 attacks should have occurs
Cyclic vomiting
recurrent episodic attacks of vomiting and intense nausea lasting from 1hr to 5days. Attacks are associated with pallor and lethargy. There is complete resolution of sx btw attacks. At least 5 attacks
Migraine without aura- dx
- at least 5 attacks
- headache lasting 4-72hrs
- at least 2 of following (characteristic of headache)
- -unilateral location
- -pulsating quality
- -moderate or severe pain intensity
- -aggravation by or causing avoidance of routine physical activity
- during headache at least 1
- -nausea and/or vomiting
- -photophobia and phonophobia
Migraine with aura
Aura- lasting 5-60mins -fully reversible.. visual sx sensory sx dysphasic speech disturbance
Familial hemiplegic migraine (FMH)
presents with transient hemiplegia during aura
- Ophthalmoplegia- double vision
- Strabismus- paralysis of EOMs
Basilar migraine**
Visual field disturbances, cerebbellar signs (ataxia, dysarthria)
Cranial nerve involvement (vertigo)
Sensory and motor involvement
Bickerstaff’s migraine
basilar migraine in adolescent females
-Total blindness*, accompanied by admixture of vertigo, ataxia, dysarthria, tinnitus, perioral paresthesia, and occasional confusional state
Migraine -non-pharmacological tx
identify and remove triggering factors -alcohol -food -hunger -irregular sleep patterns -organic odors -sustained exertion -glare, flashing light -acute stress avoid environmental factors -time zone shift, weather changes, pressure changes Menstrual cycle
Migraine- pharm tx- acute
NSAIDS
Triptans* (DOC, selective 5HT1 agonist, contraindicated in pts with CVD*)
Ergotamine, dihydroergotamine (non selective 5HT1)
Metoclopromide, prochlorperazine (DA antagonists)
Narcotic analgesics
Migraine- prophylactic tx
Indication: 3 or more attacks a month
- beta blocker: propranolol*
- Ca channel blocker: Flunarizine*
- 5HT agonist: methysergide, cyproheptadine
- anticonvulsants: sodium valproate
Tension type headache
Headache- bilateral, tight, band like pain (not throbbing) No nausea or vomiting No prodrome Not aggravated by physical activity Frontal-occipital location
Tension type headache- tx
Relaxation
NSAIDS
Prophylactic: TCA anti-depressants (Aitriptyline, Doxepin, Nortriptyline)
Cluster headache-info
Sudden periorbital or temporal pain unilateral Reaches crescendo within 5mins Lasts 30mins-2hr associated with -homolateral lacrimation -reddening of eye and nasal congestion -ptosis -nausea Alcohol provokes (70%) Nocturnal (50%; awakens pt within 2hrs of falling asleep) Periodic (occur at the same hour everyday)
Cluster headache- tx
100% oxygen mask for 15min** (abortive) Sumatriptan Prednisone Lithium Ergotamine
Chronic paroxysmal hemicrania
brief, severe unilateral orbital, supraorbital or temporal throbbing pain
Lasts 2-45mins*
At least 50 attacks a day
Pain with at least one of following
-1: conjunctival injection, 2: lacrimation, 3: nasal congestion, 4: rhinorrhea, 5: ptosis, 6: eyelid edema
Chronic paroxysmal hemicrania- tx
Indomethacin (150mg daily or less): absolutely effective***
Cough headache
headache on coughing, bending, sneezing, lifting
MRI is usually indicated to rule out structural anomalies/ brain tumor
-Chiari malformation
sx associated with SERIOUS underlying cause of headache
- worst headache ever
- first severe headache
- ‘Thunderclap’ headache
- Subacute worsening over days or weeks
- Abnormal neurological exam
- Fever or unexplained systemic signs
- Vomiting precedes headache
- Induced by bending, lifting, coughing
- Disturbs sleep or present immediately upon wakening
- Known systemic illness
- Onset age after 55yrs
Headache- brain tumor/ space occupying lesion (SOL)
may worsen with exertion and change in position
pain appear with bending, lifting, coughing-> posterior fossa tumor
early morning headache that improves with day*
Unilateral papilledema
Temporal arteritis
Headache- worse at night and on exposure to cold
Tenderness and redness over temporal arteries
Loss of vision or impaired vision
Polymyalgia rheumatica*
Jaw claudication* (pain with chewing)
Bx: dx
Tx: prednisone 4-6 weeks
Acute glaucoma
IOP>21mmHg
Pathological cupping of optic disc
Loss of field of vision
Acute glaucoma- tx
- Block aqueous production: Timolol, Acetazolamide
- Reduced vitreous volume: oral glycerol, mannitol
- Facilitate aqueous outflow: pilocarpine*
- surgical: Iridotomy
Acute sinusitis
Pain or tenderness over sinuses
dx- CT shows mucosal thickening
tx- decongestants (Pseudoephedrine)
Idiopathic intracranial hypertension (IIH)(Pseudotumor cerebri)
Increased ICP without any evidence of brain path
associated with VitaminA, Nalidixic acid, Danazol, Steroid withdrawal
Tx: Acetazolamide, Corticosteroids, Furosemide, CSF shunt (Ventriculoperitoneal shunt)
Analgesic rebound headache- tx
Stop analgesics
Hydroxyzine*
Trigeminal neuralgia- tx
Carbamazapine*
Radiofrequency ablation of a portion of the trigeminal ganglion
Anesthetic blocks
Headache after Lumber Puncture
Increases on sitting and standing and decreases on reclining and on increasing abdominal pressure
Headache after Lumbar Puncture- tx
if pain persists
- Caffeine sodium benzoate**
- Epidural blood patch (if CSB fails)
