Clinical Perspectives of Headache Disorders Flashcards
What is the difference between a primary and secondary headache?
A primary headache has no identifiable cause, whereas a secondary headache is due to some underlying cause (tumor, hemorrhage, meningitis, etc).
True/False. The dura surrounding the vascular sinuses and vessels is pain insensitive.
False. While dura over the skull is pain insensitive, dura around vascular structures is pain sensitive
What are the pain-insensitive brain structures?
Brain parenchyma, ependyma, choroid plexus, pia matter, arachnoid, dura over the skull
The falx cerebri is pain (sensitive/insensitive)
Pain-sensitive
True/False. Drainage of CSF in the supine position reduces headache.
True. Draining CSF in the erect position causes the brain to compress pain-sensitive structures
Lesions above the tentorium refer pain where?
Forehead and behind the eye
Pain in the ear and back of the head is often due to lesions where?
Posterior fossa
What red flags indicate a potentially dangerous headache?
Systemic or neurologic symptoms, sudden onset, older age, prior history, pattern change
A patient comes to the clinic feeling unwell, with minimal neck movement. You check Kernig’s sign. What indicates a positive test?
Severe pain in the lower back
A physician flexes the neck of a patient with meningitis. What would be the expected reaction?
Flexion of the lower extremities to reduce pain - this is called Brudzinski’s sign
What is one of the common causes of subarachnoid hemorrhage?
Ruptured intracranial aneurysm
What is sentinel hemorrhage?
Leakage from a vessel into the subarachnoid space before rupture of an aneurysm
What symptoms characterize a subarachnoid hemorrhage?
Sudden onset of a very severe headache
What are the most common sites of aneurysms?
PCA, ACA, middle cerebral bifurcation
What is the most common type of migraine?
Migraine without aura
What signs characterize a cluster headache?
Severe pain around the eye often accompanied by rhinorrhea and watery eyes, more common in men and smokers
A basilar-type migraine includes headache with additional symptoms referred from the vertebrobasilar circulation. These symptoms include…?
Dysarthria, vertigo, tinnitus, deafness, diplopia, ataxia, decreased level of consciousness, bilateral sensory deficits
This type of migraine includes weakness that may last longer than 60 minutes.
Hemiplegic migraine
Cycling vomiting, abdominal pain, and benign paroxysmal vergito are associated with what unusual migraine disorder?
Childhood periodic syndromes
Ophthalmoplegia migraines are a secondary headaches associated with what cause?
Cranial neuralgia - especially CN III
A patient experiences approximately 3 days of headaches per month. Is preventative treatment recommended in this patient?
No - preventative treatment is recommended with 6 or more days of headaches per month
What is the recommended first-line therapy for acute migraine treatment?
Triptans & NSAIDs
A 36yo woman comes to the clinic with interest in beginning oral contraceptives. PMH is significant for 10-pack-year smoking history and migraines with aura. What is the recommended course of action?
The woman should NOT be prescribed oral contraceptives due to 9x higher risk of stroke. Other contraceptive methods should be considered
True/False. Migraine without aura is associated with a twofold increase in the risk of stroke in women.
False. Migraine WITH aura is associated with increased stroke risk. This risk increases with use of oral contraceptives and smoking
True/False. In women with increased risk of stroke and vascular conditions, non-estrogen-containing oral contraceptives should be used.
True. If women are also 35+ and have migraines with aura, no oral contraceptive should be used
Pericranial tenderness characterizes this headache type?
Tension-type headache
What symptoms generally accompany cluster headaches?
Unilateral orbital/temporal pain, rhinorrhea, lacrimation
What population is at greatest risk for cluster headaches?
Men who are smokers
What medication may be used to prevent cluster headaches?
Verapamil
What medication may be used to treat active cluster headaches?
Prednisone, sumatriptan
What are the two sites most likely for cervical artery dissection?
Internal carotid & vertebral arteries
