HA (Exam #3) Flashcards
What are the four types of HA?
- Vascular (migraine, cluster)
- Muscle contraction (tension)
- Traction)
- Inflammatory
Which type of HA is the most common DIAGNOSIS given?
Migraine HA
Which type of HA involves unilateral throbbing, pulsating lasting 4-72 hours?
Migraine HA
Which type of HA involves “PIN”, and what does this stand for?
Migraine HA
- Photophobia
- Incapacitating
- N/V
What type of HA involves allodynia?
Migraine HA
What does a “classic” migraine look like?
Migraine WITH aura
What does a “common” migraine look like?
Migraine WITHOUT aura
- PIN sxs; HA without warning, chronic recurring
What are the four phases of a “classic” migraine?
- Prodrome
- Aura
- HA
- Postdrome
What phase of a “classic” migraine presents as food cravings, mood change, yawning, fluid retention, constipation?
When does this present?
Prodrome
- 24-48 hours pre-HA
What phase of a “classic” migraine presents as +sxs (visual, auditory, sensory motor) and -sxs (loss of function, vision, hearing, sensation, motor)?
When does this present, and how long doe sit typically last?
AURA
- 10-60 minutes pre-HA
- Lasts 60 minutes
How do the actual HA sxs of a Migraine WITH Aura differ from a Migraine WITHOUT Aura?
BOTH: unilateral throbbing/pulsatile pain
- WITH: N/V OR photophobia OR phonophobia
- WITHOUT: PIN (photophobia, incapacitating, N/V); allodynia
When might a CT be ordered to evaluate a Migraine HA (4)?
- “Worst HA of life”
- Change in HA presentation
- New/unexplained neuro sxs
- Refractory
What is the first line treatment for a mild/moderate migraine HA (3)? Severe HA (2)?
- Mild/moderate: NSAID, Acetaminophen, Excedrin
- Severe: Triptans, Ergots
What AE may be seen with the use of Triptans for Migraine HA?
“Triptan Sensation”
- Injection site rxn, CP/heaviness, flushing, weakness, drowsy
What AE is seen with both Triptans and Ergots? What is the main CI associated with these drugs?
VASOCONSTRICTION (dig deep to Pharm ppl)
- CI if pregnant
What three drugs can be considered for Migraine HA prophylaxis?
- Propranolol (BB)
- Amitriptyline (antidepressant)
- Topiramate (anticonvulsant)
Which type of HA is the most COMMON HA?
Tension-Type HA (TTH)
Which type of HA involves bilateral pressure lasting 30 min. to 7 days?
Tension-Type HA (TTH)
Which type of HA involves “band-like” pressure?
Tension-Type HA (TTH)
Which type of HA is associated with anorexia, head/neck pain with muscle pain, bruxism?
Tension-Type HA (TTH)
How are ALL HA diagnosed? Which two can also involve imaging, and what type of imaging is preferred?
CLINICAL
- Migraine HA = CT
- Cluster HA = MRI
What is the main tx for Tension-Type HA (TTH)? What other tx is also recommended?
NSAIDs
- Also, tx underlying condition (jaw/mouth, sleep study, less stress)
Which type of HA is the most DEBILITATING HA?
Cluster HA
Which type of HA is more common in males than females?
Cluster HA
Which type of HA involves excruciating unilateral sharp, boring periorbital HA lasting 15 min. to 2 hours?
Cluster HA
What other sxs (besides pain in the head) are seen with Cluster HA?
Autonomic sxs
What is the timeline for each type of HA?
- Cluster = 15 min. to 2 hour
- Migraine = 4-72 hours
- Tension-Type = 30 min. to 7 days
What is recommended for acute tx of Cluster HA (2)?
- 100 O2 at 12+ L/min
- Sumatriptan given SC
What is recommended for preventative tx of Cluster HA?
Verapamil (CCB)
What type of HA involves 15+ days/month for 3+ months; moderate pain on sides/top of head?
Chronic Daily HA
What type of HA involves continuous, fluctuating pain on same side of face/head lasting minutes/days?
Hemicrania Continua
What is the recommended tx for Hemicrania Continua?
Indomethacin
What type of HA involves abrupt onset & unremitting throbbing/tightening on both sides of head?
New Daily Persistent HA (NDPH)
What is the recommended tx for New Daily Persistent HA (NDPH)?
Muscle relaxants
What type of HA involves “ice pick” or “jabs and jolts”?
Primary Stabbing HA
What type of HA involves sudden onset intense pain that strikes without warning lasting 1-10 seconds; often around eye?
Primary Stabbing HA
What is the recommended tx for Primary Stabbing HA?
Indomethacin
What type of HA involves triggered by cough, sneeze, intense activity; lasts minutes to days?
Primary Exertional HA
What type of HA is also called the “alarm-clock” HA? What age group is it often seen?
Hypnic HA
- 50+ years (occurs late in life)
What is the recommended dx test for Hypnic HA?
MRI
What is the recommended tx for Hypnic HA? What med can also be considered?
Caffeine at night
- Indomethacin
What type of HA occurs during sleep and awakens patient; throbbing on both sides of head?
Hypnic HA
What two groups of meds can create increased risk for Medication Overuse HA (MOH)?
- Opioids
- Barbs
Secondary HA presenting with sxs worse with cough, exertion, straining, position is indicative of?
Pseudotumor cerebri
Secondary HA presenting with sxs worse with steady/worsening + neuro sxs, nighttime awakenings is indicative of?
Brain tumor
Secondary HA presenting with “thunderclap HA”, decreased LOC is indicative of?
SAH
Secondary HA presenting with age 50+ years, throbbing temporal pain with TTP is indicative of?
Temporal Arteritis
What is the tx for Medication Overuse HA (MOH)?
NSAIDs
- ASA and Acetaminophen can make it worse
