Head Pain Flashcards
what are some causes of eye pain that can cause a headache?
corneal (FB, abrasion, erosion, EKC, dryness, trichiasis), scleritis, light sensitivity/photophobia
what are some causes of periocular pain that may cause a headache?
near point stress, orbital mass or eyelid mass, sinusitis, neuralgia, and herpes zoster
what are the two causes for light sensitivity/photophobia?
light scattering within the eye or true photophobia
what can cause light scattering in the eye?
dirty glasses, dry eye, ocular media (cataract, ocular dystrophy), rule out iritis, low RPE pigment, idiopathic
what can cause true photophobia?
iritis (anterior uveitis) until proven otherwise or other iris pathology
what is strong evidence for near point stress diagnosis?
if the patient answers yes to the question = does cessation of the activity alleviate the symptoms
what are the signs and symptoms of near point stress?
both eyes, frontal headaches, worse at the end of the day, gritty/burning eyes, some redness, general fatigue, tiredness, need frequent breaks
what is the treatment for near point stress?
functional disorders = vision therapy
computer users = computer glasses
how do you test for an orbital mass or eyelid mass?
seeing it or by touch - use retropulsion and compare both eyes
could also be a chalazion or hordeloum
any orbital mass needs imaging
how do patients with sinusitis present?
pain at/over sinus, associated with rhinorrhea, nasal congestion, recent cold, failure to transilluminate sinus
what are the 4 types of primary headaches?
migraine, tension, TAC, and chronic daily
what are TAC primary headaches?
TAC = trigeminal autonomic cephalalgias
cluster, paroxysmal hemicrania and SUNCT types
pain is neuralgiform and accompanied by autonomic hyper- or hypo-activity
what is a cluster headache?
comes every 8-16 months (2 per year), lasts for 2-12 weeks, headaches occur 2-3 times per day and last for 1 hour
do not occur between cluster periods (remission is 6-24 months)
what type of pain occurs with cluster headaches?
highly excruciating, hot poker
always unilateral (around/behind eye)
may awaken during the night
who typically gets cluster headaches?
males > females (larger men), 20-40 years old
what do people with cluster headaches do?
they often pace the floor - being still makes the pain worse
what are some associations with cluster headaches?
trigeminal and parasympathetic pain, conjunctival injection/tearing, post-ganglionic horners, nasal stuffiness, cigarette smoking
what is paroxysmal hemicranial?
parasympathetic activation ipsilateral to the pain
> 5 attacks per day, 2-30 minutes long, unilateral, neuralgiform, periocular pain
may be chronic or episodic
what is SUNCT?
short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing
what is the pattern/frequency for migraine headaches?
recurrent (1 per year - 5 per week), lasts 24 hours, unilateral pain, pulsating/throbbing, exacerbated by exercise
who typically gets migraines?
often run in families, females > males, starts in childhood
what are some migraine triggers?
stress, alcohol, red wine, cheese, chocolate, activities
what are some associations with a migraine?
gastrointestinal upset, nausea, photophobia, phonophobia, +/- aura
how is an aura different from a TIA or retinal detachment?
an aura is usually the hour before the migraine
a TIA = lasts 3-10 minutes (doesn’t move/dark)
RD = 5-30 seconds
is it possible to have a migraine without an aura?
yes = aura without headache, ophthalmic migraine or cephalic migraine
what tests should you do if a patient reports having an aura with or without a headache?
conduct VF to rule out = permanent damage to the visual system and etiology other than primary migraine
what is a tension headache?
lasts 0.5 hours to 7 days, steady pressing or vice-like pain, worse at the end of the day, bilateral and wide spread, negative for migraine signs
what are the triggers for tension headache?
stress, fatigue, not eating (physical activity doesn’t make pain worse/better)
what can tension headaches lead to?
depression due to its relentlessness
what are daily persistent headaches?
present upon waking up or begin in morning, 1 hour - all day (usually 4-6 hours), gradually gets worse or better, dull/steady bilateral pain
what are medication overuse or rebound headaches?
due to frequency of analgesic use for treatment of chronic headaches
what is a “kid headache”?
rule out migraines and near point stress
conduct a thorough exam
what are the 8 types of secondary headaches?
pseudotumor cerebri, mass (tumor, aneurysm), subdural hematoma, chemical, trauma/illness/infection, menstrual, ice cream, myopia/uncorrected refractive error, medications
describe the headache pain in pseudotumor cerebri patients
gradual onset, generalized and bilateral, dull and steady
accompanied by blurry vision, visual obstructions (papilledema) and diplopia (CN6)
what are the signs and symptoms of a brain tumor?
focal neurological signs or seizures, nausea, vomiting, impaired mental status
what are the signs and symptoms for a subdural hematoma?
slow onset (after blunt trauma or fall), headache starts mild, neurological signs, change in mental status, usually no papilledema and elevated ICP
