9.5 Flashcards
A sudden onset of a “thunderclap” could be a sign of what?
Subarachnoid Hemorrhage
Absence of prior HA similar to present one could be a sign of what?
CNS infection
Focal neurological signs could be a
stroke or tumor
HA with symptoms like fevers could be
Meningitis
HA with rapid onset of exercise could be ____________ associated with a ____________.
Intercranial hemorrhage
brain aneurysm
HA associated with nasal congestion could be?
sinusitis
HA associated with papilledema (swelling of the optic nerve) could be?
Intracranial pressure
What are reasons you would refer someone with a HA for imaging?
(1) Recent change in pattern, frequency, or severity of headaches
(2) Progressive worsening despite therapy
(3) Focal neurological deficits or scalp tenderness
(4) Onset of headache with exertion, cough, or sexual activity
(5) Visual changes, auras, or orbital bruits
(6) Onset of headache after age 40
(7) History of trauma, hypertension, fever
What is the most prevalent headache?
Tension headaches
What kind of headache is categorized as:
1) Bilateral
2) Daily
3) “Vice-like”
4) Exacerbated by emotional stress, fatigue, noise, glare
5) May be associated with hypertonicity excessive tone of neck muscles.
Tension headache
What is the treatment for tension headaches?
NSAIDS:
-Ibuprofen 400/800mg PO q4-6
-Naproxen 250/5000mg PO q12
Tylenol 325mg PO q 4-6
What headaches is categorized as:
1) Usually affects middle aged men
2) Unilateral pain around the temple or eye
3) Restless and agitated due to the pain
4) Episodes often occur 15 minutes to 3 hours
5) Usually occur Seasonally and are grouped together
6) Rhinorrhea, Lacrimation, Horner’s syndrome
7) After resolution, hiatus of several months
Cluster headache
Horner’s syndrome is usually associated with what type of headache?
Cluster headache
What are the 3 components of Horner’s syndrome?
- Ptosis
- Miosis
- Anhidrosis
What is the initial treatment for Cluster headaches?
100% oxygen for 15min
What is your 2nd and 3rd line of treatment for Cluster headaches?
2nd: SubQ Sumatriptan 6mg may repeat once in 1 hour
3rd: Oral Zolmitriptan 2.5mg may repeat in 2 hours
What is a contraindication for using Sumatriptan and Zolmitriptan?
Ischemic heart disease
What are characteristics of Migraines?
1) Gradual build-up of a throbbing headache
2) Unilateral or bilateral
2) Lasts several hours
3) Aura or Visual disturbances such as field deficits, hallucinations (stars, light slashes, zigzags, etc)
4) Focal disturbances such as aphasia or numbness, tingling,
clumsiness, or weakness in a circumscribed distribution
5) Family hx
6) Nausea and vomiting
What are examples of avoiding precipitating factors for migraines?
During acute attacks rest in a quiet, dark room until sx subside
What are some Migraine Abortive Treatments?
- NSAIDS
- Sumatriptan 25,50, 100mg
- Zolmitriptan 2.5mg can repeat in 2 hours
When should Migraine Prophylaxis be considered?
when migraines occur more than 2-3 times per month or associated significant disability
If migraines are related to hypertension what med should you consider?
Antihypertensives such as Beta-blockers, Propanol or Metoprolol
If migraines are stress/depression related what type of medication should be considered?
Antidepressants such as Amitriptyline
If migraines are related to seizures what meds should be considered?
Anticonvulsants such as Topiramate
Treatment for concurring migraine sx such as nausea can be treated with?
Antiemetics such as Promethazine
When do Post traumatic headaches occur?
Within 1-2 days of a head injury
Post traumatic HA are often accompanied by…
impaired memory, poor concentration, emotional instability, and increased irritability
What is first line treatment for post traumatic HA?
Analgesics
50% of patients with daily chronic HA are suffering from what type of HA?
Medication overuse HA
Patients who typically present with chronic pain from HA that are unresponsive to medication and have a Hx of heavy use of analgesics, likely have?
Medication Overuse HA
What is the treatment for Medication Overuse HA?
when can the pt expect improvments?
Withdraw from medications
months not days
What is an abnormal, excessive, hypersynchronous discharge from an aggregate of CNS neurons?
Seizure
What are the 5 types of Headaches?
- Tension
- Cluster
- Migraine
- Post-traumatic
- Medication Overuse
Sudden onset of a “thunderclap” headache could be
Subarachnoid hemorrhage
What are the 2 types of seizures?
- Partial seizures
- Generalized seizures
What are the 2 types of Partial seizures?
- Focal seizures with retained awareness
- Focal seizures with impaired awareness
What are the 5 types of generalized seizures?
- Tonic-clonic
- Tonic
- Clonic
- Absence
- Atonic
