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503 > Exam 1: Headaches > Flashcards

Exam 1: Headaches Flashcards

1
Q

What are the red flags of a headache in and adult?

A 
Sudden onset
Worst or first headache ever 
Thunder clap headache
Fever, neck stiffness (meningitis, encephalitis?)
Mental status changes
New headache in patient <5 or >50
Worsening pattern to a chronic headache
Focal neurological signs (other than aura)
Papilledema
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2
Q

What are 3 types of headaches, typically seen in primary care, that have no specific cause?

A

Migraine
Tension-type
Cluster

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3
Q

T/F: Primary headaches do not have a specific cause?

A

True

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4
Q

T/F: Secondary headaches have an underlying structural or metabolic cause?

A

True

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5
Q

T/F: Migraines, tension, and cluster headaches are secondary headaches?

A

False; they are all examples of primary headaches

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6
Q

T/F: Mild HTN can cause a headache?

A

False; must have malignant HTN to cause a headache

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7
Q

T/F: Eye strain is a common cause of headache?

A

False

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8
Q

What patient history is important for headache?

A 
Any aura or prodrome
Number/frequency per month
Family history (especially females of family)
Recent trauma
Time and mode of onset
Age of onset
Changes in vision
Quality, site, radiation of pain
Precipitating/relieving factors
Response to previous treatments
Changes in sleep, exercise, weight, or diet
Birth control method
Effects of menses
Change in work and lifestyle
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9
Q

What is included in the physical exam for headache?

A

BP, heart rate
Listen for carotid bruit in neck
Palpate head, neck and shoulder areas (rule out sinus isues)
Check temporal/neck arteries
Examine spine and neck muscles for tightening

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10
Q

What is included in the neuro exam for a headache?

A 
Cranial nerves
Fundoscopic exam (papilledema, etc)
Tandem gait (walk straight line)
Romberg test
Symmetry of motor, sensory, and reflex skills
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11
Q

What are symptoms of a migraine headache?

A

Pain: pulsatile, throbbing, unilateral
Nausea/vomiting
Photophobia/Phonophobia

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12
Q

What are symptoms of a brain tumor?

A

Can have pain at any time, day or night; can awaken person from sleep

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13
Q

What are symptoms of a tension-type headache?

A

Pain: band-like, dull, nagging, vice-like, steady, non-throbbing
Location: usually bilateral

*** No N/V or photo/phonophobia

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14
Q

What are the indications for sending a patient for imaging for headache?

A

Worst headache ever
Unexplained abnormal neuro exam finding
Recent change in pattern, frequency, or severity
Progressive worsening despite appropriate treatment
Onset with exertion, cough, or sexual activity (could suggest lesion/mass)
Onset after age 40-50

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15
Q

What imaging/procedure would you order for worst headache ever?

A

CT (quick check for bleed)

Lumbar puncture if concern for meningitis

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16
Q

Name some common migraine triggers

A 
Foods (chocolate, cheese, red wine, msg, nitrites, fried foods, oranges)
Menses
Change in weather
Stress
Alcohol
Hunger
Fatigue or lack of sleep
Loud noises
Flickering lights
Noxious stimuli (perfumes, etc)
Nitroglycerin
Minor head trauma
Exertion
Surgical menopause
17
Q

Which headache is most common: migraine, tension, or cluster?

A

Tension headache is most common but patients usually present for treatment of migraine as they can treat at home for tension headache

18
Q

T/F: All migraine sufferers get an aura 30-60 minutes prior to the headache?

A

False: Only about 20% of migraines have auras (mostly visual)

19
Q

What is scotoma?

A

Partial vision loss, loss of visual field, or blind spot in vision (aura)

20
Q

What is the criteria to diagnose migraines?

A

Attacks lasting 4-72 hours
Normal neuro exam
No other reasonable cause for headache

AND, at least 2 of the following:
Unilateral pain 60% of time
Throbbing/pulsating pain
Aggravation by movement or activity
Moderate to severe intensity

PLUS, at least 1 of the following:
Nausea and vomiting
Photophobia or phonophobia

21
Q

What are common abortive treatments for mild migraine symptoms?

A

OTC: NSAIDS, APAP, ASA, Excedrin, caffeine
If one NSAID doesn’t work, try another one
Prescription: Triptans, Fioricet

    • Early treatment is most effective
    • Large, single dose works best
    • Over use of Fioricet can cause rebound headaches
22
Q

What are common abortive treatments for moderate to severe migraine symptoms?

A
  • Moderate inhibits daily activity but not incapacitating
    OTC: NSAIDS, Aleve, antiemetics for N/V
    Triptans especially in combination with Aleve
    Benzos can be used to get the patient to sleep (possibly breaking the migraine)
  • Severe incapacitating should go to ED for IV treatment
23
Q

What is the first-line preventative (prophylactic) treatment for migraines?

A

Beta blockers (propranolol) - most effective treatment studied
CCB (verapamil) - not as effective as a BB but may relieve aura
Tricyclic antidepressants (amitriptyline)
Anticonvulsants (valproate/Depakote, topiramate/Topamax) [BLACK BOX WARNING: risk for suicide for those with major depression]

** If first-line doesn’t work, refer to neuro

24
Q

Define episodic tension headache

A

At least 2 of the following:
Pressing/tightening, non-pulsating, squeezing, vice-like
Mild to moderate intensity (inhibits but does not prohibit activity)
Bilateral
No aggravation from routine physical activity

Both of the following:
No nausea or vomiting
Photophobia or phonophobia absent, or only one present

25
Q

What are the treatments for tension headaches?

A

OTC: APAP, ASA, NSAIDs (start with ibuprofen), Aleve
Triptans NOT helpful
If OTC does not work may add caffeine but can cause rebound headaches

Prophylaxis usually unnecessary but if prescribed - Amitriptyline

26
Q

What are the characteristics of a cluster headache?

A

Severe “ice pick” piercing pain behind one eye and temple
Tearing
Rhinorrhea
Ptosis
Miosis (extreme constriction of pupil) on one side (Horner’s syndrome)
Typically affects middle aged males

27
Q

What is the treatment for a cluster headache?

A

Oxygen at least 12L with mask for 15 minutes
Sumatriptan (Imitrex) by injection or intranasal

Prophylaxis: verapamil daily

28
Q

What are the red flags in pediatric headaches?

A 
Patient < 5
New onset
Focal neurological signs
Nocturnal awakening with headache
Difficulty waking child in the morning
Vomiting
Significant change in headache pattern
Papilledema
Head trauma with LOC > 10 minutes
Inability to control headache with appropriate treatment
29
Q

T/F: Pediatric migraines are bilateral and often shorter in duration than an adult’s.

A

True: pediatric migraines are often bilateral

30
Q

What are the abortive treatments for pediatric migraines?

A

OTC: NSAIDs most effective, APAP (NSAIDs most effective per studies)
Antiemetics (suppositories, PO)
Sedatives (Benadryl, then benzos)
Triptans (not FDA approved for younger than age 18 but are used safely and effectively)
Sumatriptans > age 12

31
Q

What are the most common headaches in kids?

A

Migraine

Tension

32
Q

Secondary headaches in pediatric patients are usually due to _______.

A

Viral infections, possibly with:

Fever
Sinusitis
Pharyngitis
Acute otitis media
Mono
Mild head trauma
33
Q

T/F: Most headaches in kids/teens are not due to serious underlying disorders.

A

True

34
Q

What is the risk of mixing triptans and SSRIs?

A

Serotonin syndrome (often begins within about 6 hours of taking the medication or increasing the dose)

Mild cases include high blood pressure and a fast heart rate; usually without a fever. Symptoms in moderate cases include high body temperature, agitation, increased reflexes, tremor, sweating, dilated pupils…

35
Q

T/F: Parents are the best source for patient history when seen for headaches?

A

False: Interview patient alone as well as with the parents. Children often describe history more accurately than their parents.

36
Q

A patient complains of headache that occurs regularly and may worsen with changes in atmospheric pressure or when stooping. Which type of headache could this be?

A

Sinus headache

37
Q

An older patient comes in with complaints of a headache to his right temple. He admits to tenderness to his scalp and the right temple. You examine his temple area and it is reddened and warm to the touch. What is your diagnosis?

A

Temporal arteritis; this is a medical urgency to prevent blindness

503 (16 decks)

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