Exam 3 Headaches Flashcards
Causes of HAs? (5)
Disturbed pain-sensitive structures Distention/dilation of IC arteries CSF path obstruction Primary central pain Genetics
Primary HAs include? (4)
Migraine
Cluster
Tension
Rebound
Migraine symptoms:
Gender?
Loc?
Character?
Duration?
Pt presentation?
Ass’c sxs?
a/w?
F 3:1
Loc = U unilat, Bifront, global
Char =
Gradual onset, crescendo, pulsate
Mod-severe
Routine activity aggravates
Dur = 4 - 72 hrs
Pt = Resting in dark/quite
Ass = N/V, Photo/Phonophobia
P aura
a/w = FHx, period
Tension symptoms:
Gender?
Loc?
Character?
Duration?
Pt presentation?
Ass’c sxs?
Precipitated by?
F > M
Loc = Bilat
Char =
Pressure/Tightening
Mild-mod
Waxes/wanes
Dur = 30 min - 7 days
Pt = Stays active or rests
Ass = Neck tension, Bruxism (grind teeth), Anorexia
Pre = stress
Cluster symptoms:
Gender?
Loc?
Character?
Duration?
Pt presentation?
Ass’c sxs?
Precipitated By?
Male
Loc = Always unilat, U eye or temple
Char =
Quick onset, crescendo w/i mins, continuous
Deep/Explosive/Excrutiating
Dur = 30 - 90 min, 1 - 6/day for wks
Pt = Active
Ass = Ipsil tearing/redness Congestion/Rhinorrhea Pallor Sweating Horner's Sensitive to EtOH Focal neuro is rare
Pre = EtOH, nitro, smoking, stress
Migraine U begin?
Types? (4)
< 40 yo
1) w/o Aura (most C)
2) w/ Aura (pre-HA)
3) Basilar (Visual aura, vertigo, dysarthria, ataxia, bilat paresthesia, syncope)
4) Ophthalmoplegic (Unilat oculomotor palsy w/ diplopia, ptosis, dilated pupil)
Aura onset/duration?
Where in brain?
Sxs? (4)
5-20 min onset
Resolves w/i 60 min
Cerebral cortex or brainstem
Homo visuals
Hemi paresthesia/numb
Hemi weakness
Dysphasia
Aura vs TIA:
Onset?
Duration?
Pattern?
Onset:
A = multiple episodes, gradual
T = new event, sudden
Duration:
A = < 1 hr
T = 24 hrs
Pattern:
A = Progress/Regress
T = Constant
Rebound HAs caused by?
Loc/Severity?
Exacerbated?
Management?
Overuse of analgesics
Varies
Physical/Emotional effort
Refer
2° HAs include? (7)
Craniofacial structure disorders Cranial neuralgias CSF pressure Tumor Trauma Vascular defects Infection
2° HA presentation? (12)
1st intense HA or 1st severe HA > 50 yo Nuchal rigidity Kernig sign Brudzinski sign Diplopia Papilledema/Retina hemorr New/Persistent neuro signs Fever ↑↑ BP Unexplained V Triggerd by exertion Hx head trauma, CA, coagulopathy
Kernig Sign?
Sign of meningitis: Stiffness of the hamstrings
Pt supine
Raise hip and knee to 90°
Can’t straighten the leg w/ hip flexed
Brudzinski Sign?
Sign of meningitis: Pt supine Hand behind neck, hand on chest Bend head forward Pt flexes hips/knees in response
SNOOP for 2° HA Red Flags?
S = Systemic sxs (Fever, Wgt Loss) or
Secondary risk factors (HIV, CA, infection, menengitis, vasculitis)
N = Neuro sxs (confusion, ∆d MS)
O = Onset (sudden)
O = Old (new HA > 50 yo)
P = Pervious HA, Hx of (no Hx or character is different)
Systemic sxs P due to? (5)
HIV CA Infection Meningitis Vasculitis
Neuro sxs P due to? (3)
Non-vasc IC disorder
Tumor
Drug abuse
Sudden onset P due to? (3)
Ruptured aneurysm
IC bleed
Venous sinus throm
Onset > 50 yo P due to? (4)
Polymyalgia rheumatica
Tumor
Hydrocephalus
Giant cell arteritis
Hx of no HA or this HA is different P due to?
meds
2° HA due to Craniofacial Structure Disorders such as? (3)
Sinuses
Deviated septum
TMJ
2° HA due to Cranial Neuralgias such as? (2)
Trigeminal
Occipital
2° HA due to CSF Pressure such as? (2)
Benign IC HTN (worse w/ cough/exertion)
Lumbar puncture
2° HA due to Temporal Arteritis presentation?
Diagnostic study?
Tx?
> 50 yo
Throbbing temple, tender
↑ ESR
Temporal artery bx
High steroids
CT/MRI indicated for HA when? (7)
Unexplained ↓ alertness/cognition Trigger w/ exertion Nuchal rigidity Focal neuro 1st HA > 50 yo "Worst ever"
CT/MRI NOT indicated if what?
ALL of the following:
Previous identical HA Vitals = N Alert/cognition intact Supple neck No neuro signs HA improves w/o meds
Acute Migraine tx: Mild-Mod? (4)
Analgesic + anti-nausea
Excedrine (ASA, acetamin, caffeine)
Midrin (vasocon, acetamin, sedative)
NSAIDs
Acute Migraine tx: Mod-Severe? (4)
Triptans (serotonin agonists/vasocon):
Imitrex, Zomig
Ergots (vasocon)
Triptan sensations?
Post tx:
Short-lived tingle, hot, heavy, tight chest, flushing, dizzy
Triptan/Erog contraindications?
Uncontrolled HTN Hx of heart dz CV dz Peripheral vascular dz Preggos Hemiplegic/Basilar migraine
Migraine prophy?
NSAIDs TCA/SSRI β-block CCB Depakote (val acid)
Cluster tx?
Prophy?
Abortive:
100% O2 by mask
Ergots/Triptans
Intranasal lidocaine
No smoking/EtOH/stress
Same as migraine meds
Lithium
Prednisone
Refer HAs out when? (6)
Inadequate tx Uncertain dx Believe underlying pathology Refractory Chronic/daily HA ↑ demand for meds
