HA lokin ver

Question 1

define HA

Answer 1

aka cephalgia - most common neurologic symptom

pain above the orbitomeatal line

93% of men and 99% of women

Question 2

what are the pain sensitive cranial structures

Answer 2

skin, subcutaneous tissue, muscles, extracranial arteries and external periosteum of the skull

structures of the eye, ear, nasal cavities and paranasal sinuses

intracranial venous sinuses and large tributaries

dura at base of brain and proximal ACA, MCA, intracranial ICA

middle meningeal and superficial temporal arteries

CN and 1st 3 cervical nerves

Question 3

structure not sensitive to pain

Answer 3

brain parenchyma

Question 4

what is primary HA

Answer 4

no other causative disorder that brings HA

migraine
tension
cluster and other trigeminal autonomic cephalgia
other primary HA

Question 5

what is secondary HA

Answer 5

occur closely temporally to another disorder that is known to have manifestations of headaches

Question 6

what is trigeminal myalgia

Answer 6

presents as central or facial pain

Question 6

discuss approach to HA

Answer 6

is there underlying cause - secondary; if need ng tests edi red flag

no underlying - primary

Hx is im unless secondary HA

quality - tightness, burning, sharp, stabbing, throbbing

intensity
location
onset, variation, duration
precipitating, aggravating, relieving

Question 6

usual physical exam findings

Answer 6

auscultation of skull and palpation of head

tender areas - temporal arteritis, cranial metastasis, and sinus headache.

nuchal rigidity - meningeal

Question 6

what are the HA red flags (systemic ssx)

Answer 6

malignancy - metastases

fever - CNS infection

lmyphoma, strep meningitis, strep, toxoplasmosis

Question 7

what are the HA red flags (neurologic findings)

Answer 7

imply focal structural neurologic lesions

Question 7

what are the HA red flags (onset)

Answer 7

sudden or abrupt - TCA

Subarachnoid hemorrhage

Cerebral venous sinus thrombosis
Reversible cerebral vasoconstriction syndrome

Cervical artery dissection

Apoplexy

Question 7

what are the HA red flags (4P)

Answer 7

postural - HA changes when standing up; intracranial HTN or CSF leak

precipitating, progression, papilledema

tinnitus

obese or child c tetracycline - PTC or pseudotumors

Question 8

HA green flags

Answer 8

current headache has already been present during childhood

occurs in temporal relationship with the menstrual cycle

headache-free days

family members have the same headache

HA occurred or stopped more than one week ago

Question 9

what to advice people c PTC

Answer 9

lose weight

acetazolamide - if may visual probs

lumbar puncture or lumbar train