Clinical Correlations With Headaches Flashcards
Primary vs secondary headaches
Primary = recurrent headaches that originate form the head and have no other associated causes
Secondary = headaches that’s are caused by something else and are often isolated events (don’t reoccur)
Examples of secondary headaches
Referred pain from neck/eyes/sinuses/teeth/jaw/nose/mouth
Trauma to the head or neck
Intracranial or cervical vascular disruption
Substance abuse or withdrawal
Infections within sinuses, respiratory tract, dental or CNS
Psychiatric disorders
What is the most common type of primary headaches
Tension (40%)
Migraines (10%)
Cluster (1%)
Tension headaches
most common headache syndrome
Characteristics
- mild-moderate intensity
- bilateral
- non throbbing and has a “band-like” appearance in the fronto-temporal,occipital and TMJ regions.
- minimal features and associated symptoms
- unremarkable PE
Treatment:
- NSAIDs=, acetaminophen, ASA, OMT, herbal remedies.
Why should you limit any abortive headache medications to less than 2 times a week?
If using 3 or more time, causes rebound headaches due to withdrawal
Migraines
Roughly 10% of the population gets these
Risk factors
- genetics (defects in the trigeminal nerve signaling pathways)
- age (starts when teenager, peaks in 30s-40s and declines with age)
- gender (women more likely than men)
- hormones (withdrawal of estrogen and menopause encourages it and haunts it respectively.)
- diet, environment and lifestyle triggers
Characteristics of migraines
- moderate- severe
- unilateral
- throbbing and pounding headache
- accompanied by nausea, vomiting, photo/phonophobia
- is disabling
- lasts 4-72 hrs
Chronic migraines is characterized by what?
15 or more migraines a month for 3 months
Status migrainosus
A migraine that lasts over 72 hrs.
This is an emergency
Phases of a migraine
1) Premonitory/prodromal
- starts hours/days before a migraine
- photo/phonophobia
- increased urination/ diarrhea
- fatigue and mood changes
2) aura stage
* ONLY OCCURS IN 20-30%*
- lasts 5-60 minutes and occurs usually before the headache (but now always)
- visual or sensory lines
- speech/language disabilities
- motor strength defects
3) headache stage
- lasts under 72 hrs
4) postdrome (migraine hangover)
- lasts up to 72 hrs after the migraine
- depression
- increased sleepiness and decreased concentration
Most common environmental triggers
Stress (80%)
Hormone changes (65%)
Fasting (57%)
Weather changes (53%)
Sleep disturbances (50%)
Neck pain/tension (38%)
Lights and alcohol (38%)
Heat (30%)
Exercise (22%)
Sex (5%)
What is special considerations for patients with aura migraines
Birth control pills are contraindicated
Triptans are contraindicated
Consider preventative emend actions for sure patients
Increased aura rates are present with increased risks of strokes
What neuropeptide is most likely associated with migraines
CGRP proteins
When is dexamethasone used for headaches?
For repetitive headaches
Calms down the inflammation that occurs with repetitive headaches
When is medications for migraines (triptans and ergots) indicated
1) any patient who gets migraines 4times or more a month
2) any patient that experiences aura migraines
3) any patient that experiences rebound headaches
4) any patient who’s headaches are so severe that NSAIDs, OTCs, and lifestyle changes aren’t working and its debilitating
What are the 4 main classes of migraine preventative medications?
1) BBs
2) CBBs
3) antidepressants (amitriptyline and sertraline)
4) anticonvulsants (gabapentin, topiramate)
