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Unit 13 > HA > Flashcards

HA Flashcards

1
Q

Three classifications of HA disorders

A

1) primary
2) secondary
3) cranial neuralgias

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2
Q

Most common kind of HA

A

primary

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3
Q

Red flags for HA

A

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)

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4
Q

is a positive family hx of similar primary HA comforting or concerning

A

comforting

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5
Q

Name the three kinds of primary HA

A

1) tension
2) migraine
3) TAC/cluster

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6
Q

What is the most common type of primary HA

A

tension

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7
Q

subjective: tight band around the head is what kind of HA?

A

tension HA

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8
Q

is tension HA unilateral or bilateral?

Is nausea generally associated with it?

Is it always related to muscle tension?

A

bilateral

No nausea or light sensitivity

Not always related to muscle tension

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9
Q

Four characteristics for a migraine you 2/4 to conclude migraine

AND

at least one of what two things

A

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

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10
Q

migraines onset?

A

hours to days

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11
Q

What % of patients

A

1/3 of migraine patients

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12
Q

Spreads graudually, takes <60 minutes, usually precedes HA, and is fully reversible

A

Migraine aura

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13
Q

True or false, you can only have a visual aura?

A

false: visual, sensory, language, motor and brainstem

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14
Q

Differential dx btwn migraine and stroke

A

migraine has a gradual onset, stroke is not gradual

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15
Q

Cortical spreading depression/neurologic deficit creates what?

A

migraine aura

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16
Q

Trigeminocervical complex

Where is it?

What happens here?

A

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

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17
Q

Prodrome

A

before HA

Prodrome –> aura–> HA –> postdrome

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18
Q

Is a migraine just a HA?

A

NO

prodrome: irritability, mood changes etc.
aura
HA
postdrome: fatigue, lethargic

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19
Q

Are migraines more common in men or women?

What age group has highest prevelance?

A

3:1 female

22-55 yrs

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20
Q

Two reasons someone w/ hx of HA should get imaging?

A

significant or abrupt change in pattern (higher frequency, not responding to tx like normal, different location, constant HA)

new neurologic symptoms

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21
Q

True or false, lifestyle modifications are important for tx of migraines

A

true, comprehensive tx is important

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22
Q

Migraine pharmalogical tx two kinds

A

Acute/abortive medications: stop once its already started (the sooner the better)

Preventive/prophylactic: to decrease frequency

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23
Q

First line of pharma tx for acute migraines, why?

A

Triptans: migraine specific

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24
Q

Who is triptans contraindicated in?

A

individuals with vascular disease

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25
Q

Name the classes of drugs that are commonly used as preventive medications for migraine

A

Antihypertensives

Antiepileptics

Tricyclic antidepressants

CGRP antibodies: injection

26
Q

When do you start thinking about preventive medication for migraines?

A

4 more more migraines per month

27
Q

botox, nerve blocks, and neurostimulation can all be used for what kind of HA?

A

Migraines

28
Q

Signs of TAC (trigeminal autonomic cephalalgias)

A

unilateral HA

Unilateral parasympathetic features (eyes tearing or redness, nasal congestion, runny nose)

29
Q

nature of cluster HA’s (3 things)

A

cyclic nature (season, time of day)

15-80 min duration: shorter than migraines generally

Restless

30
Q

Explain why someones HA decreasing from supine to standing may be concerning?

A

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

31
Q

Ischemic stroke
Epidural hematoma
Tumor

Are all causes of what?

A

increased ICP

32
Q

If someone has low ICP when would their HA present?

What is the cause of low ICP?

A

in standing vs. in supine

Caused by leaking of CSF (lumbar punctures, or spinal tap) or insidious

33
Q

What kind of bleed is caused by a ruptured aneurysm or trauma?

A

subarachnoid hemorrhage

34
Q

two risk factors for aneurysm (causing subarachnoid hemorrhage)

A

smoking

HTN

35
Q

What could be a common cause of thunderclap HA?

A

ruptured aneurysm –> subarachoid hemorrhage

36
Q

medication overuse, rhinosinusitis, sleep apnea, TMD and cervicogenic HA are all common causes of what?

A

secondary HA

37
Q

Is cervicogenic HA primary or secondary?

A

secondary!

38
Q

Is TMD HA primary or secondary?

A

secondary!

39
Q

migraine chronification associated with

A

> 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

40
Q

What is commonly misdiagnosed as a “sinus HA?”

A

rhinosinusitis: inflammation of nasal cavity and sinuses

41
Q

Fever, purulent nasal discharge consider?

A

HA due to rhinosinusitis

42
Q

Do radiographic findings of sinus infection correlate with HA’s?

A

NO

43
Q

if HA is abolished following blockage of cervical structure or its nerve supply what kind of HA?

A

cervicogenic HA

44
Q

HA is worse with provocative movement and has a temporal relationship to head movmeent what kind of HA?

A

cervicogenic

45
Q

Where do pain signals converge?

What two signals are converging?

A

Trigeminocervical complex

Cervical input (C1-3) and trigeminal input

46
Q

Does the location of pain give us a good way to know where the pain is stemming from?

A

no referred pain can be from a lot of different places

47
Q

C1 and C2 can refer to where?

A

Head and neck, shoulder

48
Q

Cervicogenic HA presentation

A

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

49
Q

Imaging for cervicogenic HA?

A

not helpful, no corresponding radiologic findings

50
Q

Tx of cervicogenic HA

A

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

51
Q

Evidence for anesthetic blockades for cervicogenic HA?

A

Poor quality evidence

52
Q

what population are cervical myofascial trigger points more common in?

A

chronic tension type HAs compared to controls

53
Q

Trigger points can be attributed to what two things?

A

forward head posture

cervical dystonia

54
Q

What kind of pain is cranial neuralgia?

A

deep, sharp, radiating, “electric shock”

Head, neck and facial pain but its not really a HA

55
Q

Brief electric shock pain over mandible and maxillary area is probably what?

A

trigeminal neuralgia of V2 and 3

56
Q

What is trigeminal neuralgia generally treated with outside of PT?

A

surgery, medication

May have underlying cause such as vascular compression

57
Q

What kind of neuralgia is common in migraines?

A

occipital neuralgia

58
Q

What can you do to elicit occipital neuralgia pain?

A

palpate greater or lesser occipital

59
Q

What tx do you use to target occipital neuralgia?

A

nerve blocks

60
Q

Cervicogenic headaches are homogenous in nature?

A

no! cervicogenic HA are a syndrome!!

61
Q

Warning signs for dangerous HA?

A

sudden onset, positional changes (ICP component)

Unit 13 (6 decks)

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