HA Flashcards
Three classifications of HA disorders
1) primary
2) secondary
3) cranial neuralgias
Most common kind of HA
primary
Red flags for HA
SNOOP
S: systemic symptoms and secondary risk factors (HIV, cancer)
N: neurologic signs
O: onset is abrupt, peak <1 min
O: >50 yrs old
P: postural, positional, papilledema (looking at things that signal an increase in ICP)
is a positive family hx of similar primary HA comforting or concerning
comforting
Name the three kinds of primary HA
1) tension
2) migraine
3) TAC/cluster
What is the most common type of primary HA
tension
subjective: tight band around the head is what kind of HA?
tension HA
is tension HA unilateral or bilateral?
Is nausea generally associated with it?
Is it always related to muscle tension?
bilateral
No nausea or light sensitivity
Not always related to muscle tension
Four characteristics for a migraine you 2/4 to conclude migraine
AND
at least one of what two things
1) unilateral
2) pulsing
3) moderate to severe pain
4) aggravation by or causing avoidance of routine PA
1) nausea and/or vomiting
2) photophobia and phonophobia
migraines onset?
hours to days
What % of patients
1/3 of migraine patients
Spreads graudually, takes <60 minutes, usually precedes HA, and is fully reversible
Migraine aura
True or false, you can only have a visual aura?
false: visual, sensory, language, motor and brainstem
Differential dx btwn migraine and stroke
migraine has a gradual onset, stroke is not gradual
Cortical spreading depression/neurologic deficit creates what?
migraine aura
Trigeminocervical complex
Where is it?
What happens here?
It is in the brain stem
This is the point where both central and peripheral input converges and is sent up to the cortex. Accounts for fatigue and photophobia being coupled with pain from HA
Prodrome
before HA
Prodrome –> aura–> HA –> postdrome
Is a migraine just a HA?
NO
prodrome: irritability, mood changes etc.
aura
HA
postdrome: fatigue, lethargic
Are migraines more common in men or women?
What age group has highest prevelance?
3:1 female
22-55 yrs
Two reasons someone w/ hx of HA should get imaging?
significant or abrupt change in pattern (higher frequency, not responding to tx like normal, different location, constant HA)
new neurologic symptoms
True or false, lifestyle modifications are important for tx of migraines
true, comprehensive tx is important
Migraine pharmalogical tx two kinds
Acute/abortive medications: stop once its already started (the sooner the better)
Preventive/prophylactic: to decrease frequency
First line of pharma tx for acute migraines, why?
Triptans: migraine specific
Who is triptans contraindicated in?
individuals with vascular disease
Name the classes of drugs that are commonly used as preventive medications for migraine
Antihypertensives
Antiepileptics
Tricyclic antidepressants
CGRP antibodies: injection
When do you start thinking about preventive medication for migraines?
4 more more migraines per month
botox, nerve blocks, and neurostimulation can all be used for what kind of HA?
Migraines
Signs of TAC (trigeminal autonomic cephalalgias)
unilateral HA
Unilateral parasympathetic features (eyes tearing or redness, nasal congestion, runny nose)
nature of cluster HA’s (3 things)
cyclic nature (season, time of day)
15-80 min duration: shorter than migraines generally
Restless
Explain why someones HA decreasing from supine to standing may be concerning?
increased ICP in supine
in standing some of that CSF can get transmitted to the SC decreasing the pressure.
papilledema (optic nerve swelling) is finding of increased ICP
Ischemic stroke
Epidural hematoma
Tumor
Are all causes of what?
increased ICP
If someone has low ICP when would their HA present?
What is the cause of low ICP?
in standing vs. in supine
Caused by leaking of CSF (lumbar punctures, or spinal tap) or insidious
What kind of bleed is caused by a ruptured aneurysm or trauma?
subarachnoid hemorrhage
two risk factors for aneurysm (causing subarachnoid hemorrhage)
smoking
HTN
What could be a common cause of thunderclap HA?
ruptured aneurysm –> subarachoid hemorrhage
medication overuse, rhinosinusitis, sleep apnea, TMD and cervicogenic HA are all common causes of what?
secondary HA
Is cervicogenic HA primary or secondary?
secondary!
Is TMD HA primary or secondary?
secondary!
migraine chronification associated with
> 8 days of opiods use
10 days of triptans in combo with analgesic
10-15 days per month of NSAIDS
After removing overused acute medications 1/3 of pts HA symptoms improved
What is commonly misdiagnosed as a “sinus HA?”
rhinosinusitis: inflammation of nasal cavity and sinuses
Fever, purulent nasal discharge consider?
HA due to rhinosinusitis
Do radiographic findings of sinus infection correlate with HA’s?
NO
if HA is abolished following blockage of cervical structure or its nerve supply what kind of HA?
cervicogenic HA
HA is worse with provocative movement and has a temporal relationship to head movmeent what kind of HA?
cervicogenic
Where do pain signals converge?
What two signals are converging?
Trigeminocervical complex
Cervical input (C1-3) and trigeminal input
Does the location of pain give us a good way to know where the pain is stemming from?
no referred pain can be from a lot of different places
C1 and C2 can refer to where?
Head and neck, shoulder
Cervicogenic HA presentation
Precipitation of head pain w/neck movement or pressure over upper cspine or occipital area
Ulilateral
Ipsilateral neck, shoulder or arm pain; occasionally radicular
Occipital location
Not responsive to acute migraine medication
Imaging for cervicogenic HA?
not helpful, no corresponding radiologic findings
Tx of cervicogenic HA
Anti inflammatories, neuroopathic pain meds, PT
Anesthetic blockades: to occipital nerves, facet joints or segmental nerve roots
If positive response to anesthetic blockage consider ablative procedures
Evidence for anesthetic blockades for cervicogenic HA?
Poor quality evidence
what population are cervical myofascial trigger points more common in?
chronic tension type HAs compared to controls
Trigger points can be attributed to what two things?
forward head posture
cervical dystonia
What kind of pain is cranial neuralgia?
deep, sharp, radiating, “electric shock”
Head, neck and facial pain but its not really a HA
Brief electric shock pain over mandible and maxillary area is probably what?
trigeminal neuralgia of V2 and 3
What is trigeminal neuralgia generally treated with outside of PT?
surgery, medication
May have underlying cause such as vascular compression
What kind of neuralgia is common in migraines?
occipital neuralgia
What can you do to elicit occipital neuralgia pain?
palpate greater or lesser occipital
What tx do you use to target occipital neuralgia?
nerve blocks
Cervicogenic headaches are homogenous in nature?
no! cervicogenic HA are a syndrome!!
Warning signs for dangerous HA?
sudden onset, positional changes (ICP component)
