HA Flashcards
Most common neurological disordrer
HA
50% + americans report at least 1 HA per year.
1/3 people have severe headaches.
__% of HA are high risk
1%
Most headaches are caused by ____ or ____ problems
Muscle contraction or blood flow
How many different types of HA
over 100
3 types of primary HA
Tension-Type Headache (TTH): 78%
Migraine: 13-18%
Cluster: 0.4%
Common location of:
TTH
Migraine
Cluster
TTH: Pain like a band squeezing the head. Across forehead.
Migraine: Unilateral. Visual changes are typical of classic form.
Cluster: Pain is in and around 1 eye. (but does not originate in eyes)
Are primary or secondary more commonly associated with severe findings?
Secondary. HA caused due to systemic problem.
Secondary headaches may be due to
Fasting Sinusitis Infections- meningitis, dental abscess. Stroke Trauma Tumor Refractive/ocular disease. Less urgent. Medication over use
HA red flags
- New HA type in pt over 50
- HA increasing in frequency or severity
- HA wakes pt from sleep
- HA + systemic finding such as fever or coughing/straining
- HA + neurological symptoms. Numb, tingling, slurred speech
- HA + papilledema
- HA with altered mental status. Confusion, memory probs
- HA with nausea or vomiting if NEW.
majority of all HA
TTH
TTH two types
Acute/episodic or chronic (15+ days per month)
TTH more common in women or men
Women
Why are TTH due to a dysfunction of pain perception
Persistent myofascical input (constant contracting muscle somewhere) causing pain and sterile inflammation (No infection)
Signs and symptoms of TTH
Bilateral, dull, band like tightness 4-6 hours No photophobia or phonophobia (hearing sensitivity) Doesn't worsen with physical activity Responds to OTC meds
TTH causes
Emotional/physical stress
depression and anxiety
Working in awkward positions- Tech neck.
TTH Tx
OTC NSAIDS
Caffeine
Exercise
Stress reduction therapy
How much of the population is affected by migraines
13%
Female> Male
Migraineurs
- Most prevalent in ages:
- __% have immediate family Hx
- History of
- Strong correlation with
25-55 years old (may be associated with arteriolosclerosis)
70% with FHx
History with car sickness and vertigo as child
Strong correlation with depression/anxiety due to neurological differences in serotonin/dopamine.
4 stages of a migraine
- Prodrome
- Aura
- Attack/HA
- Postdrome
Migraine stage 1: Prodrome
1-2 days prior to attack These could be signs of a migraine coming: Constipation Depression Diarrhea Drowsiness Irritability
Migraine stage 2: Aura
occurs right before attack (20-30 mins)
Usually visual
Migraine stage 3: Attack
Moderate to severe pain
lasts several hours- 3 days
Migraine stage 4: Postdrome
Migraine hangover.
Malaise
Fatigue
What is happening in the brain that causes a migraine?: Neurovascular theory
Neurobiology + Vascular function in the brain
Pt’s who get migraines have lowered threshold to stimuli, which leads to cortical hyper-excitability followed by cortical spreading depression (CSD). Excessive firing of neurons that activates trigeminal nerves and causes pain in dural blood vessels.
Hyper-excitability starts in occipital lobe and spreads to central sulcus.
Cortical spreading depression (CSD)
Excessive firing of neurons that activates trigeminal nerves and causes pain in dural blood vessels.
How to diagnose migraine using 54321
5 or more attacks
4 hours- 3 days in duration
2 or more of the following:
Unilateral, throbbing, moderate/severe pain, causes avoidance of routine physical activity
1 or more of the following:
Nausea, vomiting, photophobia, phonophobia
Two main Migraine types
- Migraine without aura (80%) Common migraine
- Migraine with aura (20%) Classic migraine
Others: Retinal (not a true migraine) Childhood periodic syndromes Complication Probable migraine- hasn't met all 54321 criteria Chronic migraine
Common migraine (without aura) has a 25% increased risk of ___ and ___
Stroke and MI
What types of HAs improve with sleep
Migraines
Signs/symptoms of common migraines without aura
Progressively worsen, unilateral, throbbing
Nausea, vomiting
photo and phono phobia
Anorexia
Improves with sleep
Conj injection and tearing due to neuromuscular prob
In what type of migraine might you see conjunctival injection and tearing
Common and classic
How does 54321 change with classic migraine (with aura)
24321
Only have to have 2 attacks, not 5
Migraine with aura (classic migraine) has 2x risk of ___ in women and ____
MI in women
Ischemic stroke in male/females
Fancy name for migraine with aura
scintillating scotoma
How does a scintillating scotoma (aura) progress?
may last 20-60 mins.
- Initial paracentral scotoma
- Enlarging scotoma 7 mins alter
- Scotoma obscuring much of central vision 15 mins later
- Break up of scotoma at 20 mins
Pts may have aura without headaches. More common in
Men over 40
Retinal migraine is due to
Vascular spasm causing an interruption in ciliary or retinal circulation. Visual disturbances are result of retinal ischemia.
Amaurosis fugax- may be due to stroke. Sudden loss of vision in 1 eye.
Signs/symptoms of retinal migraines
Transient, monocular visual disturbance
Usually brief
HA before or after the visual episode
Usually under age of 40
Most common cause of transient vision loss under age 45
Aura
Ocular manifestations of migraines
Aura
Hemianopsia: Persistant VF defect up to weeks after attack.
Horners syndrome- rare
Normal tension glaucoma- associated
Normal tension glaucoma is associated with
Ocular manifestations of migraines
Are OTC meds effective for migraines?
Usually no
How to tx migraines
Prophylactically
Abortive tx- take in the moment to decrease severity or duration
Avoid triggers- food, alcohol, stress, lights, smells
Cluster headaches
Severe, unilateral pain usually involving the eye.
Attacks occur in clusters- last for weeks to months. Headaches last 15-180 mins. May occur once every other day or up to 8x per day.
How common are cluster headaches, in which genders and what are risk factors?
Men 0.4%, women, 0.08%
80% are heavy smokers and 50% are alcoholic users
What makes cluster headaches so painful?
Involves changes to the trigeminal pain processing.
Autonomic features of cluster HA
Nasal congestion, facial sweating, lacrimation, conj redness, mitosis, and ptosis. Usually unilateral.
TMJ syndrome
Pain in trigeminal and facial nerve areas
Originates in the jaw and worsens with chewing
Differentiating sign: Jaw clicking or locking.
5% of population, ages 15-40. F>M
Ocular causes of HA
Angle cosure Uveitis Scleritis Optic neuritis Refractive disorders and muscle imbalance Metastatic orbital tumors Severe dry eyes
Ophthalmodynia periodica-
Shooting eye pain that diminishes quickly in one eye.
Prob occurs along CN V ophthalmic branch. Often hx of migraines Benign Cause unknown Tx art tears
Benign Episodic pupillary mydriasis
Acute, unilateral mydriasis. Blown pupil. Always co-manage with neuro.
Women> men
Hx of migraines
associations: Blur, light sensitivity, HA. Similar to dilated symptoms.
Headache work up
History Cranial nerve eval Sinus eval Blood pressure refraction Binocular/accom testing Complete ocular health assessment Visual field testing Refer to neuro
Consider brain scan if you suspect
Tumor hx of seizures Recent head trauma Signifcant changes to HA Abnormal neuro signs
