Clinical Approach to Headache (Hon) Flashcards
What are signs which may indicate headache of pathological origin (Secondary HA-Organic Disease)
1) Worst HA of life
2) Onset of HA after age 50
3) HA with fever
4) Abrupt onset
Any HA patient with a “worrisome history” or abnormal examination needs what urgent imaging study?
What should be done next if the above imaging is normal?
1) CT head with and w/o contrast or MRI of the head
2) Lumbar puncture
1) How is the intensity of a common migraine characterized?
2) At what age does the prevalence peak?
3) Which sex is it more common in?
4) Where is the location?
5) How is it described?
6) What is the typical response associated?
7) Do common migraine patients experience an aura?
1) Moderate to severe
2) 35-40 years
3) Females
4) Unilateral or bilateral
5) Throbbing, sharp, pressure
6) Retreat to dark, quiet room
7) No
What are the most common associated symptoms of a common migraine?
1) Nausea
2) Vomiting
3) Photophobia
4) Phonophobia
An aura is associated with what type of migraine?
How long does it usually last?
What are the most common symptoms assocaited?
1) Classic migraine
2) 15-30 min
3) Visual symptoms
How is a chronic migraine classified?
1) HA for 15 or more days per month
2) HA lasts 4 hours or longer
3) For a period of at least 3 months
1) How is the intensity of a Tension-Type HA characterized?
2) Does it prohibit daily activities?
3) Where is the location?
4) How is it described?
5) Do Tension-Type HA patients experience an aura?
6) What is the Frequency of Episodic and Chronic Type?
7) What is the Duration of Episodic and Chronic Type?
1) Mild to Moderate
2) No
3) Bifrontal, bioccipital
4) Dull, aching, squeezing, pressure
5) No
6) Episodic <15 days per month
Chronic Type >15 days per month
7) Episodic: Several Hours
Chronic Type: All Day; Wax Wane
1) How is the intensity of a Cluster HA characterized?
2) Which sex is it more common in?
3) What condition is it associated with?
4) Where is the location?
5) What is the typical response associated?
6) Are there any disability?
7) What is the age onset?
8) What is the duration?
9) Is there an Aura?
1) Severe, excruciating, non-throbing
2) Men
3) Obstructive sleep apnea
4) 100% unilateral; generally orbitotemporal
5) Frenetic, pacing, rocking
6) Prohibits Daily Activity
7) 20-50’s
8) 30 minutes to 2 hour
9) No
What are associated symptoms of cluster HA?
1) Ipsilateral ptosis
2) Miosis
3) Conjunctival injection
4) Lacrimation
5) Stuffed or runny nose
SCLIMP
Triptans which can be used in the acute treatment of migraine are contraindicated in what scenarios?
What is another treatment for migraine?
1) Ischemic heart disease
2) Raynaud’s syndrome
3) Uncontrolled HTN
4) Severe renal or hepatic impairment
DHE Protocol
What is the only FDA approved treatment for chronic migraine?
BOTOX injections
What can be used to treat cluster HA?
WHat are preventative Tx?
Oxygen 100% 8L/min by mask
-CCB, Valproic Acid, Lithium, Indomethacin
Paroxysmal Hemicrania
- Symptoms
- Duration
- Frequency
- What are they exquisitely responsive to?
- Unilateral, Periorbital, lacrimation, conjunctival irritation (Similar to cluster but shorter)
- Shorter (minutes compared to Cluster HA)
- increased frequency (>5 per day)
- Indomethacin
Which Migraine has Aura and which does not
Classic Migraine has aura
Common Migraine does not have aura
What are Trigeminal Autonomic Cephalgias
Name the types
Group of Headache disorders with unilateral trigeminal distribution pain and ipsilateral cranial autonomic issues
- Cluster HA,
- Paroxysmal hemicrania
- Hemicrania
- SUNCT (Short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing
- SUNA Syndrome (SUNCT but Autonomic Sx)
