Aquifer Case 18 Flashcards
1
Q
when do you do neuroimaging for a HA?
A
- migraine with atypical HA patterns or unexplained abnormalities on neuro exam
- high risk of significant abnormalities like
associated head trauma
new or changing HA over the age of 50
new or changing HA in those less than 6
2
Q
what are signs of increased intracranial pressure?
A
- papilledema
2. altered mental status
3
Q
which findings are suggestive of migraine headaches?
A
- severe HA 1-2 times weekly
- unilateral and throbbing in nature
- associated nausea, photophobia and hyperacusis
- fHx of migraine
- increased caffeine consumption and poor sleep are possible triggers
- normal neuro exam
4
Q
which findings are suggestive of tension type headaches?
A
- mild to moderate bilateral HA that last all day on most days
- pain that radiates down neck with tender occiput
- increased stressors and poor sleep in recent weeks are triggers
- normal neuro exam
5
Q
what are some triggers for tension HA and migraines?
A
- aspartame and phenylalanine
- caffeine
- emotional stress
- intense exercise
- sleep disturbance
- menses/ovulation/pregnancy
- fasting
- estrogen; aka OCPs
- tobacco, caffeine, alcohol
- aspartame and phenylalanine like from diet soda
6
Q
when do you start HA prevention?
A
prevention should be initiated if:
1. at least 6 HA days per month
- at least 4 headache days with at least some impairment
- at least 3 HA days with severe impairment or requiring bed rest
prevention should be considered if:
1. 4-5 migraine days per month with normal funcitoning
- 2-3 migraine days per month with some impairment
- 2 migraine days with severe impairment
7
Q
what are the goals of HA prevention?
A
- decrease attack frequency by 50% and decrease intensity and duration.
- improve responsiveness to acute therapy.
- improve function and decrease disability.
- prevent the occurrence of a medication overuse headache (MOH) and chronic daily headache
