HA Flashcards
primary causes of migraine
i. HA & associated features are the disorder
ii. Tension 69%
iii. Migraine 16%
iv. Cluster 0.1%
secondary causes of migraine in order
i. HA caused by other disorder
ii. Infection 63%
iii. Trauma 4%
iv. Vascular Disorder 1%
v. SAH <1%
vi. Tumor 0.1%
what types of infections cause headaches
sinus infection- pressure on sinuses, tops of the teeth
meningitis- nuchal rigidity, fever, rash, body aches
dental abscess
headaches in the population M:F
b. 5:9 M:F
cluster more common in males
migraines more common in females
TTH presentation
time
and location
pain is constant an daily an worse late in the day
bilateral
vise-like band
vi. Emanates from neck and shoulders
“Featureless” HA
TTH
NO associated sx like n/v
ix. S.C.A.L.P (PE)
- skin
- Connective Tissue
- Aponeurosis í connected to the skin
- Loose connective tissue
- Pericranium íoutside of the bony cranium
- Occipital nerves are superficial and attached to the capitis muscles
triggers for TTH
- Stress
- Depression/Anxiety
- Posture
- Jaw clenching when sleeping
- Female - get more tension HA’s than males do
- Middle age
how to differentiate TTH in a person with anxiety or depression
pts with mental health issues wake up with HA and they get worse throughout the day
chronic TTH
at least 10 episodes month at least 30 minutes location bilateral pressing or tigehtning no n/v no photophobia
best way to treat a HA
at the onset
on’t treat your HA like an earthquake
OTC analgesic snd drink a ton of water
less likely to progress and reoccur
caffeine can be helpful
caffeine helps HA becasue
is a vasoconstrictor
what to avoid with TTH
Opiates
amitriptyline (TCA)
works really good as a low dose for TTH
usually want to take it at night because it can cause drowsiness
EMG
biofeedback therapy that can be used to treat TTH
ALT to medication for TTH
acupuncture
maybe massage
TENS tx
Transcutaneous Electrical Nerve Stimulation
causes nerve stimulation of mm and can reset nerves and help mm to stay more relaxed in
TTH of in pts with chronic back pain
onset of migraines
6-8 in boys
after menses in women
Fhx in what % of pts with migraines
70%
Pathophysiology of migraines
vasonstriction followed by vasodilation theory kind of debunked
looks like more of a nuero vascular issue with spreading that leads to trigeminal vascular system triggering and cortical spreading depression that depolarizes the cortex –> leads to blood vessel dilation
triggers inflammatory mediators to be released
triggers for migraine
- FH - predisposing factor 70%
- Stress 80%
- Lack/excess of sleep>50%
- Missed meals 57%
- Foods (chocolate, EtOH) 27-38%
- Hydration status definitely a trigger for migraine HA
- Light 38%
- Noise, glare
- Menstruation (catamennial migraines) 65%
a. Raises a whole new tx option for hormones
b. Progesterone - related to HA
i. Estrogen was added to the progesterone only BC b/c HA was a huge SE
Unilateral
Throbbing
Episodic with early onset
migraine
red flag for migraine onset
almost always start in childhood or teen years but always by the 20s
four stages of a migraine
prodrome
aura
migraine
postdrome
migraine presentation
- Unilateral
- Throbbing
- Episodic with early onset - teens & young adults
- Anorexia
- N/V
- Photophobia/phonophobia/osmophobia
a. Osmophobia - sensitivity to smells - Cognitive impairment
a. Word finding
b. Executive fxn can become a problem - Blurred vision
- Migraine HA build gradually, last hours to days
- Focal neurological deficits, or sensations may preceed onset
what % of pts have aura with migraine
25%
mc presentation of MS
optic neuritis in 40 year old woman
if you have a new onset migraine you really need to think about this
how to determine if a migraine is chronic and need prophylaxis
insurance is ver stingy with migraine medications like triptans
need to revaluate if they are using them a lot
missing school or work
decrease risk of neurological damage
menstral migraine
mngmt of acute migraine
NSAID
triptan
sumatriptain+naproxen
antiemetic
triptan injection SE
feel like shit for 20 minutes and then you’re better
triptan injections hurt
they cause muscle spasm
preventative management for migraines
lifestyle mods
BB/Anti htn meds (meto, timo, propra)
TCA antidepressants
:amitriptyline in small doses at bedtime
anticonvulsants topiramte, valproate
CCB
why would you want to avoid a BB for prophylactic mngmt
not in marathon runners (HR already low)
make you tired so be careful
heart blocks, really anything where the hr is too low
suppresses appetite can treat migraines
anticonvulsants
topiramate (topamax) and valproate
cluster ha pathophys
trigemino vascualr stimulation like migraine but in a different part of the brain (hypothalamus?)
typical trigger with cluster
alcohol
stress
glare
specific foods
CM of cluster HA
deep unilateral peri-orbital trigeminal area agitation
timing/duration of cluster HA
- Pain is “explosive” in nature
4. Episodic, episodes last weeks
associated features of cluster HA
(ipsilateral parasympathetic activation):
a. Nasal congestion, rhinorrhea
b. Lacrimation and redness of eye
c. Horner syndrome (sympathetic deficit associated with parasympathetic activation with injury to ascending fibers surrounding dilated carotid artery)
tx for cluster ha
oxygen tx –> shuts down inflammatory process
triptans
preventative mgmt
<2 mo
prednisone high dose
> 2mo verpamil
less common causes of HA
analgesia rebound substance use or withdrawl' trauma mass GCT arteritis subarachnoid hemorrhage sunken brain
what is sunken brain
post lumbar puncture
WORST HA OF MY LIFEEE
subarachnoid hemorrhage
e. Abnormal neurological examination with HA
is reason for worry
red flag
TIA or stroke
Systemic signs
rash
fever
these should make you think of infx
vomiting proceeding the HA
worried about ICH
or intracranial pressure increase
pain with pressure change
worried about ICH
or intracranial pressure increase
if a HA wakes you from sleep
and it’s not cluster think intra cranial pathology
Onset >55
j. Onset >55 - late onset is a bad sign
intra cranial thing
classic migraine does or does not have an aura?
has an aura
timing needed to dx cluster
5 episodes from 1 every other day to 8 days without other causes
imitrex
vasodilator used for migraine accompanied with SE like N/v
1st line for migraine
tylenol
d. Subacute worsening over days suggests what origin of a HA
bleeding
g. Vomiting preceding HA
ICP
