CHAPTER 1 3 HEADACHE Flashcards
what are the two types of headache?
primary and secondary headache
causes of primary headache
tension-type migraine idiopathic stabbing exertional cluster
causes of secondary headache
systemic infection head injury vascular disorder subarachnoid hemorrhage brain tumor
it is a type of headache in which the headache and its associated symptoms is the disorder itself
primary headache
type of headache where it is caused by exogenous disorder
secondary headache
pain occurs when?
peripheral nociceptors are stimulated in response to tissue injury, visceral distension or other factors
what are the cranial structures that are pain producing
scalp meningeal arteries dural sinuses falx cerebri proximal segments of the large pial arteries
what are the cranial structures that are not pain producing?
ventricular ependyma
choroid plexus
pial viens
brain parenchyma
key structures that involved in primary headache
large intracranial vessels
dura mater
peripheral terminals of trigeminal nerve
caudal portion of the trigeminal nerve
rostral pain processing regions such as the ventroposteromedial thalamus and cortex
pain modulatory systems such as hypothalamus and brainstem structures
what do you call the innervation of large intracranial vessels and the dura mater by the trigeminal nerve
trigeminovascular system
examples of cranial symptoms that may suggest trigeminal autonomic cephalagias
lacrimation conjunctival injection nasal congestion rhinorrhea periorbital swelling aural fullness ptosis
What are the symptoms of the headache that suggest that a serious underlying disorder
sudden onset headache first severe headache worst headache ever vomiting that precedes the headache subacute worsening over days or weeks pain induced by bending, lifting, cough pain that disturbs sleep or presents immediately upon awakening known systemic illnesses onset after age 55 fever or unexplained systemic signs abnormal neurologic symptoms pain associated with local tenderness
what is the essential first step in the evaluation
careful neurologic examination
history of recent-onset headache should be evaluated by?
computed tomography
magnetic resonance imaging
general evaluation of acute headache includes the?
cranial arteries by palpation
cervical spine by the effect of passive movement of the head and by imaging the investigation of cardiovascular
renal status by blood pressure monitoring and urine examination
eyes by funduscopy
intraocular pressure measurement and refraction
what other aspect should be included in the physical examination?
psychological assessment because there is relationship between pain with anxiety and depression
what is quiescent migraine syndrome?
when recurrent headache is activated by pain that follows otologic or endodontic surgical procedures
brain tumor is a rare cause of headache
True
treatment of secondary headache focuses on?
treatment of underlying condition
what do acute severe headache with stiff neck and fever suggest?
meninigitis
how do you diagnose meningitis?
lumbar puncture
in meningitis is there is striking accentuation of pain with eye movement?
yes
meningitis is easily mistaken for migraine when there is associated symptoms such as?
pounding headache
photophobia
nausea
vomitting
what do acute, maximal in <5 mins, severe headache lasting >5 min with stiff neck without fever suggets?
intracranial hemorrhage
if the intracranial hemorrhage is small what would be the result of CT scan and how to confirm it?
CT scan may be normal and LP is used to confirm
head pain in tumor is characterized as?
intermittent deep, dull aching of moderate intensity, which may be worsen during exertion and associated with nausea and vomitting
vomitting that precedes the appearance of headaches by weeks is characteristic of?
posterior fossa brain tumors
history of amenorrhea or galactorrhea with head pain is suggestive of?
prolactin-secreting pituitary adenoma
headache in patient with known malignancy is suggestive of
cerebral metastasis
carcinomatous meningitis
headache appearing abruptly after bending, lifting, or coughing can be suggestive of
posterior fossa mass
chiara malformation
low cerebrospinal fluid volume
what do you call the inflammatory disorder of arteries that frequently involves the extracranial carotid circulation
temporal (giant cell) arteritis
incidence of temporal (giant cell) arteritis
a common disease in elderly
>50
woman> men
untreated temporal arteritis can lead to?
blindless
pathophysiology of blindness in untreated temporal arteritis
involvement of ophthalmic artery and its branches
treatment for temporal arteritis
glucocorticoids
what are the typical symptoms of temporal arteritis
headache polymyalgia rheumatica jaw claudication fever weight loss
dominant symptom?
headache associated with malaise and muscle aches
what is the quality of pain in px with temporal arteritis?
throbbing
dull and boring
superimposed episodic stabbing pains similar to sharp pains that appear in migraine
pertinent finding in physical examination in px with temporal arteritis
scalp tenderness
brushing of hair or resting the head on a pillow is not possible
what could worsen the headache and aggravate?
nightime and exposure to cold
additional findings in pe in px with temporal artheritis
reddened, tender nodules
red streaking of the skin
diagnosis of temporal arteritis
erythrocyte sedimentation rate and temporal biopsy
treatment for temporal arteritis
prednisione 80 mg daily for the first 4 to 6 weeks
characteristic of headache in glaucoma px
prostrating headache associated with severe eye pain
physical examination findings in px with glaucoma
eyes is red with fixed moderately dilated pupil
when can we say that it is chronic headache?
15 days or more per month
treatment for chronic headache
treat the underlying illness
give tricylics such as amitriptyline or nortiptyline (1kg) and given 12 hr before the expected time of awakening to prevent excess morning sleepiness
what is medication over-use headache
overuse of analgesic medication for headache can aggravate headache
how to manage a medication overuse in outpatient?
reduce the medication and practice medication diary
how to manage overuse of medication in inpatient?
acute medications are withdrawn and the px must be hydrated well
what is the clinical manifestation of new daily persistent headache?
the px can recall the moment of onset
what is the most common cause of new daily persistent headache
subarachnoid hemorrhage
what is the most common cause of new daily persistent headache
subarachnoid hemorrhage
what is the characteristic of low CSF volume headache?
head pain is positional
begins when the px is sitting upright and resolves upon reclining
what is the gold standard diagnosis for low CSF headache
MRI with gadolinium
initial treatmet for CFS volume
bed rest
with persistent pain, you can give IV caffeine
characteristic of head pain in raised CSF pressure headache
chronic migraine
history of generalized of headache that is present in walking and improves as the day goes on
how can you diagnose a raised intracranial pressure?
visual obscurations
treatment for raised intracranial pressure
acetazolamide (250-500 mg bid)
