Exam 3 Headaches

Question 1

Causes of HAs? (5)

Answer 1

Disturbed pain-sensitive structures
Distention/dilation of IC arteries
CSF path obstruction
Primary central pain
Genetics

Question 2

Primary HAs include? (4)

Answer 2

Migraine
Cluster
Tension
Rebound

Question 3

Migraine symptoms:

Gender?

Loc?

Character?

Duration?

Pt presentation?

Ass’c sxs?

a/w?

Answer 3

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

Question 4

Tension symptoms:

Gender?

Loc?

Character?

Duration?

Pt presentation?

Ass’c sxs?

Precipitated by?

Answer 4

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

Question 5

Cluster symptoms:

Gender?

Loc?

Character?

Duration?

Pt presentation?

Ass’c sxs?

Precipitated By?

Answer 5

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

Question 6

Migraine U begin?

Types? (4)

Answer 6

< 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)

Question 7

Aura onset/duration?

Where in brain?

Sxs? (4)

Answer 7

5-20 min onset
Resolves w/i 60 min

Cerebral cortex or brainstem

Homo visuals
Hemi paresthesia/numb
Hemi weakness
Dysphasia

Question 8

Aura vs TIA:

Onset?

Duration?

Pattern?

Answer 8

Onset:
A = multiple episodes, gradual
T = new event, sudden

Duration:
A = < 1 hr
T = 24 hrs

Pattern:
A = Progress/Regress
T = Constant

Question 9

Rebound HAs caused by?

Loc/Severity?

Exacerbated?

Management?

Answer 9

Overuse of analgesics

Varies

Physical/Emotional effort

Refer

Question 10

2° HAs include? (7)

Answer 10

Craniofacial structure disorders
Cranial neuralgias
CSF pressure
Tumor
Trauma
Vascular defects
Infection

Question 11

2° HA presentation? (12)

Answer 11

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

Question 12

Kernig Sign?

Answer 12

Sign of meningitis: Stiffness of the hamstrings
Pt supine
Raise hip and knee to 90°
Can’t straighten the leg w/ hip flexed

Question 13

Brudzinski Sign?

Answer 13

Sign of meningitis:
Pt supine
Hand behind neck, hand on chest
Bend head forward
Pt flexes hips/knees in response

Question 14

SNOOP for 2° HA Red Flags?

Answer 14

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)

Question 15

Systemic sxs P due to? (5)

Answer 15

HIV
CA
Infection
Meningitis
Vasculitis

Question 16

Neuro sxs P due to? (3)

Answer 16

Non-vasc IC disorder
Tumor
Drug abuse

Question 17

Sudden onset P due to? (3)

Answer 17

Ruptured aneurysm
IC bleed
Venous sinus throm

Question 18

Onset > 50 yo P due to? (4)

Answer 18

Polymyalgia rheumatica
Tumor
Hydrocephalus
Giant cell arteritis

Question 19

Hx of no HA or this HA is different P due to?

Answer 19

meds

Question 20

2° HA due to Craniofacial Structure Disorders such as? (3)

Answer 20

Sinuses
Deviated septum
TMJ

Question 21

2° HA due to Cranial Neuralgias such as? (2)

Answer 21

Trigeminal

Occipital

Question 22

2° HA due to CSF Pressure such as? (2)

Answer 22

Benign IC HTN (worse w/ cough/exertion)

Lumbar puncture

Question 23

2° HA due to Temporal Arteritis presentation?

Diagnostic study?

Tx?

Answer 23

> 50 yo
Throbbing temple, tender
↑ ESR

Temporal artery bx

High steroids

Question 24

CT/MRI indicated for HA when? (7)

Answer 24

Unexplained
↓ alertness/cognition
Trigger w/ exertion
Nuchal rigidity
Focal neuro
1st HA > 50 yo
"Worst ever"

Question 25

CT/MRI NOT indicated if what?

Answer 25

ALL of the following:

Previous identical HA
Vitals = N
Alert/cognition intact
Supple neck
No neuro signs
HA improves w/o meds

Question 26

Acute Migraine tx: Mild-Mod? (4)

Answer 26

Analgesic + anti-nausea
Excedrine (ASA, acetamin, caffeine)
Midrin (vasocon, acetamin, sedative)
NSAIDs

Question 27

Acute Migraine tx: Mod-Severe? (4)

Answer 27

Triptans (serotonin agonists/vasocon):
Imitrex, Zomig

Ergots (vasocon)

Question 28

Triptan sensations?

Answer 28

Post tx:

Short-lived tingle, hot, heavy, tight chest, flushing, dizzy

Question 29

Triptan/Erog contraindications?

Answer 29

Uncontrolled HTN
Hx of heart dz
CV dz
Peripheral vascular dz
Preggos
Hemiplegic/Basilar migraine

Question 30

Migraine prophy?

Answer 30

NSAIDs
TCA/SSRI
β-block
CCB
Depakote (val acid)

Question 31

Cluster tx?

Prophy?

Answer 31

Abortive:
100% O2 by mask
Ergots/Triptans
Intranasal lidocaine

No smoking/EtOH/stress
Same as migraine meds
Lithium
Prednisone

Question 32

Refer HAs out when? (6)

Answer 32

Inadequate tx
Uncertain dx
Believe underlying pathology
Refractory
Chronic/daily HA
↑ demand for meds