Exam 3: clinical intro to headaches Flashcards
What is the typical patient to have tension-type headaches?
Younger than 40 female with high education
What is the pathophysiology of a tension headache?
Muscle contraction, compressing the greater occipital nerve, exacerbated by emotional stress
What is the clinical presentation of a tension headache?
30 min-1 week in length, pressing/tightening in headband distribution, mild to moderate intensity, bilateral, not aggravated by routine physical activity, no nausea or vomiting, phono or photophobia, but not both
Does PT work for tension headache management?
NO
What are some treatments of tension headaches
alagesics (ibuprofen), acupuncture, biofeedback, relaxation techniques
Describe the typical cluster headache patient
27-31 year old male experiences severe headaches behind the eye unilaterally multiple times a day for 3 weeks, then it stops for many months to over a year, with autonomic symptoms (Lacrimation, nasal congestion, rhinorrhea, forehead sweating)
Describe the pathophysiology of cluster headaches
Hypothalamic activation of trigeminovascular autonomic system and parasympathetics, can be genetic, can be seen in patients with a patent foramen ovale
What is the management of cluster headaches?
Oxygen 6-10L/min for 15 minutes, sumatriptan (nasally), zolmitriptan, prophylaxis of episodic clusters
Describe the clinical presentation of migraines?
20-30 year old female with intermittent, unilateral, throbbing, crescendo-decrescendo headache lasting hours to days with gradual onset, associated with nausea, may have an aura
What is the pathophysiology of migraines?
No one truly knows; could be disorder of endogenous pain modulating symptoms, subcortical structures and central modulation of afferent traffic
T/F: migrains are associated with a family history?
True, familial hemiplegic migraines are associated with the CACNA1A gene (calcium channel)
What should be avoided in migraines with auras?
Birth control (especially if it contains estrogen) and viagra,
What are first line treatments for migraines?
Triptans, DHE, perchlorperazine, metoclopramide, APAP, ibuprofen, naproxen, dexamethasone
What are the prophylactic medication for migraines?
amitriptyline, divalproex sodium/sodium valproate, propranolol, timolol
What are secondary headaches that need to be identified?
Temporal arteritis, meningitis/encephalitis, med withdrawl, intracranial malignancy, viral syndrome
