B7-001 Headache Flashcards
4 characteristics of common migraines
- unilateral location
- pulsating quality
- moderate or severe pain
- aggravation by routine physical activity
must meet two of four
common migraines must cause what symptoms during the headache [2]
nausea/vomiting
OR
photophobia/phonophobia
migraine HA preceded/accompanied by visual, sensory, or other focal neurologic symptoms
migraine with aura
a migraine lasting longer than 72 hours
status migrainosus
4 characteristics of episodic tension-type headaches
- bilateral location
- pressing/tightening quality
- mild or moderate intensity
- not aggravated by physical activity
must meet 2 of 4 characteristics
chronic daily headache is defined as greater than […] days in a month
15
can be chronic tension type or chronic migraines
a headache must have [….] cause to be classified as a migraine
no identifiable cause
most common theory about cause of migraines
Trigeminal-vascular theory
(release of CGRP by 5HT1R causes sensitization)
5HT1 agonists used for headache [3]
ergotamines (dihydroergotamine)
triptans (sumatriptan)
Ditans (lasmiditan)
5HT1 agonist that does not cause vasoconstriction
ditans (lamiditan)
**safe in patients with CVD history
CGRP antagonists
-gepants (rimegepant)
most common cause of migraines transforming to chronic migraine is
overuse of symptomatic migraine drugs and/or analgesics
typically, if a patient has more than […] headaches a month you should offer prophylactic medications
4
botulinum toxin is helpful as prophylaxis for […]
chronic migraine
does not help unless they have progressed to chronic headaches as defined by >15 a month
medication classes used for migraine prophylaxis [7]
antiepileptics
beta blockers
antidepressants
NSAIDs
herbal therapies
botulinum toxin
CGRP receptor binding
most common primary headache syndromes [2]
migraine
tension-type
severe unilateral peri-orbital pain lasting 15-180 min
cluster headache (trigeminal autonomic cephalgia)
autonomic features associated with cluster headache (trigeminal autonomic cephalgia)
conjunctival injection
lacrimation
rhinorrhea
miosis
ptosis
eyelid edema
what signs make a patient unlikely to have a sinister cause of their headaches?
long history of similar headaches with a benign outcome and normal neuro exam
red flags in chronic headache [4]
onset > 35 years old
neurologic findings, AMS
elevated ICP (papilledema)
inflammation, fever, stiff neck
types of primary headaches [3]
tension type
migraine
cluster
causes of secondary headaches
medication overuse
meningitis
subarachnoid hemorrhage
hydrocephalus
neoplasia
giant cell arteritis
tension type headaches are [bilateral/unilateral]
bilateral
migraine headaches are [bilateral/unilateral]
unilateral
cluster headaches are [bilateral/unilateral]
unilateral
last >30 min (typically 4-6 hours)
are constant
tension-type
last 4-72 hrs
migraine
last 15min- 3 hrs
repetitive
cluster
steady, bandlike pain
tension-type
symptoms of migraine
Pulsatile
One-day duration
Unilateral
Nausea
Disabling
POUND (from FA p. 534)
excruciating periorbital pain with autonomic symptoms
cluster
may present with Horners syndrome
more common in males
cluster
treatment for hemicrania continua
indomethacin
acute thunderclap headache
aneurysm
an otherwise typical migraine lasting longer than 72 hours
status migrainosus
most common cause of transformed migraine
medication overuse
transformed migraines and continuous tension type headaches are diagnosed when a patient suffers headaches […] day a month
15 or more days
a B12 or toxin would cause [pattern] symptoms and signs
bilateral symmetric
a midline structural process would cause [pattern] symptoms and signs
bilateral symmetric
a focal structural process would cause [pattern] symptoms and signs
unilateral, non-symmetric
unilateral
<3 hours in duration
ipsilateral rhinorrhea, eye injection, miosis, ptosis
cluster headache syndrome
most common headache disorder for which patient seek help from physicians
migraine
(tension type is most common overall)
migraine therapy with no vasoconstrictive properties
-ditans (lasmiditan)
migraines are caused by
centrally mediated pain sensitization
