Headache *** Flashcards

1
Q

Sx of cluster

A

Severe unilateral orbital/ supraorbital or temporal pain lasting 15-180 mins
Associated w/ (usually unilateral + ipsilateral):
Conjunctival injection
Lacrimation
Nasal congestion
Rhinorrhea
Forehead swelling
Miosis
Ptosis
Eyelid edema
Agitation
Daily HAs over weeks/ months

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2
Q

Red flags for HA

A

Fever, HTN
Confusion, altered MS, visual field defect, sz
Sudden onset
New onset in older pt

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3
Q

Triggers of clusters

A

Alcohol
Nitrates in food
Nitroglycerin
Strong odors

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4
Q

Rx for clusters - acute, bridging + maintenance

A

Acute: 100% O2 6-12L/min x15 mins + sumatriptan 6mg SC
Bridging: unilateral greater occipital nerve block 80mg methylprednisolone w/ 2ml 2% lido
Maintenance: verapamil 80mg TID (needs baseline ECG, repeat 10d after dose adjustments) , lithium, prednisone

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5
Q

Sx of concussion (acute)

A

Loss or reduced consciousness
Amnesia of events before or after injury
Altered MS at time of injury
HA, vision changes

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6
Q

Physical, emotional, cognitive + sleep sx of concussion

A

1) Physical:
HA
N/V
Visual disturbances
Photophobia
Phonophobia
Vertigo
Tinnitus
2) Emotional:
Irritability
Emotional lability
Anxiety
Fatigue
Inappropriate emotions
3) Cognitive:
Slowed reaction times
Difficulty concentrating
Poor memory
Confusion
4) Sleep:
Drowsiness
Sleeping more or less than usual

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7
Q

Immediate management of potential concussion inc how to determine need for imaging

A

Immediate: ABC, c spine control, serial monitoring for few hours (neuro + mental status). SCAT5 as sideline assessment tool
Determine need for imaging via PECARN + CT head rules

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8
Q

PECARN rules

A

GCS 14
Altered MS
Basal skull fracture
= CT

<2y/o: hematoma or hx of LOC >5s or severe mechanism or not acting normally = observation vs CT
>2y/o: LOC or vomiting or severe mechanism or severe HA = observation vs CT

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9
Q

Canadian CT head rules

A

GCS <15 2hrs from injury
Suspected open or depressed skull fracture
Basal skull fracture sign
>2 episodes vomiting
>65 y/o
Amnesia before impact >30 mins
Dangerous mechanism

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10
Q

DC instructions for concussion

A

No driving for 24hrs
Observed by responsible person for 24-48hrs
Return if deteriorates
Written + verbal advice re 1) sx of deterioration, 2) lifestyle advice + 3) typical post-concussive sx
Most recover within 3mo

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11
Q

Return to work/ school/ play guidelines

A

48hrs: physical + cognitive rest
Gradual return to activity while not increasing sx
No high risk activities for 7-10d
If symptomatic, rest for 24hrs then go back to last safe level

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12
Q

RF influencing recovery

A

Previous concussion
Skull fracture
Early onset HA
Anxiety
MVA
Delay returning to work
Lack of social supports

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13
Q

Sx migraines

A

unilateral, throbbing, N/V, photophobia, aura (visual distortion, food craving, increased sensory perception)

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14
Q

Triggers for migraines

A

temperature, noise, weather changes, odours, stress, poor sleep, menopause, menstruation, pregnancy, anxiety, OCP, citrus, caffeine, aspartame, cheese, chocolate, alcohol

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15
Q

Management (lifestyle, prophylaxis + acute) migraines

A

Lifestyle: HA diary, identify triggers, stress reduction
Prophylaxis: amitryptiline, metoprolol 47.5-200mg/d, gabapentin
Acute management: zolmitriptan + NSAIDs, maxalt 100mg

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16
Q

Tension sx

A

HA <15d/month
30mins - 7d
Pressure/ tightening
Mild-moderate
Bilateral
Not aggravated by exercise, photophobia and no N/V

17
Q

Tension management

A

Acute: Tylenol 1g, ASA 1g, NSAIDs
Prophylaxis: amitriptyline, venlafaxine
CBT

18
Q

Causes of HAs

A

Migraine
Cluster
Tension
Med induced
Tumor
Temporal arteritis
SAH
Increased ICP

19
Q

Sx temporal arteritis

A

Sudden, localised to temple
Scalp tenderness
Jaw claudication
Vision loss/ diplopia
Fever

20
Q

Ix for temporal arteritis

A

ESR/ CRP
Arterial biopsy
CBC
ALP (high)

21
Q

Rx for temporal arteritis

A

Prednisone 60mg/d

22
Q

Sx SAH

A

Thunderclap HA
Vomiting, neck stiffness
Orbital pain, diplopia, vision loss

23
Q

Ix SAH

A

CT, LP, ESR

24
Q

Rx SAH

A

mannitol/ lasix

25
Q

sx increased ICP

A

Worse over time
Worse in AM

26
Q

Ix increased ICP

A

CT or MRI

27
Q

Rx increased ICP

A

Surgery

28
Q

Types of migraine

A

Common Migraine (without aura)
Classic Migraine (with aura)
Complicated Migraine (sensorimotor symptoms)
- ophthalmoplegic
- basilar
- hemiplegic
- hemisensory
Cyclical Migraines (with menses)

29
Q

Inclusion criteria for CT head rules

A

GCS 13-15
Min 1 of:
LOC
Amnesia to the event
Witnessed disorientation

30
Q

Exclusion criteria for CT head rules

A

Age <16 years.
Blood thinners.
Seizure after injury.

31
Q

Rx for postural hypotension

A

avoid large meals, avoid alcohol, adjust meds, increase salt intake, bed tilt, elastic stockings, midodrine (alpha 1 agonist) or fludrocortisone, refer to OT

32
Q

What Ix for ?GCA

A

low risk = US, high risk = biopsy

33
Q

What nerve block can you do for acute migraine management?

A

Sphenopalatine ganglion block

34
Q

When can you use rimegepant + what class is it?

A

Migraine
Calcitonin gene-related peptide receptor antagonist

35
Q

Ottawa SAH tool components

A

age >40, neck pain/ stiffness, witnessed LOC, onset during exertion, thunderclap HA, limited neck flexion on exam

36
Q

When can you not use Ottawa SAH tool?

A

New neuro deficit, prior aneurysm, prior SAH, known brain tumor, chronic recurrent HA

37
Q

When to offer prophylactic rx for migraines?

A

If HA frequency >8 days/month

38
Q

What is cyclical vomiting syndrome associated w/?

A

Migraines

39
Q

Rx for cyclical vomiting syndrome

A

antiemetics, topiramate