Headache Flashcards
migraine (without aura)
*at least 5 attacks, lasting 4-72 hours
*at least 2 pain features: unilateral pain, throbbing pain, moderate-severe intensity, worsens with activity
*at least 1 non-pain feature: nausea and/or vomiting OR photophobia AND phonophobia
*not attributed to another disorder
tension-type headache
*30 min-7 days
*bilateral
*steady, pressing, dull (non-pulsating)
*mild to moderate intensity
*no aggravation-routine activity
*NO nausea OR vomiting
*only 1 of photo/phonophobia
migraine WITH aura
*reversible neurologic symptoms that usually precede the headache
*visual most common, but can also be sensory/motor/language
*usually lasts minutes, up to an hour
*approx 20% of those with migraines
primary headache syndromes
*headaches that do not arise as a result of another underlying disease or medical condition
*tension, migraine, and cluster
allodynia
sensitivity to touch with something not normally painful
red flags for headaches
SNOOP4:
*systemic symptoms
*neurologic symptoms/signs
*onset sudden
*older age of onset
*postural aggravation
*precipitated by valsalva
*pregnancy
*progressive
cluster headache
*at least 5 HA attacks (from one every other day to up to 8 per day)
*severe/very severe
*15 min-3 hours
*unilateral orbital, supraorbital, and/or temporal
*sense of restlessness/agitation
*any of the following conjunctival injection/lacrimation, nasal congestion, eyelid edema, forehead/facial sweating, miosis/ptosis
additional features of cluster headaches
*attacks: unilateral face, abrupt; often circadian periodicity (same time of day)
*bouts: circannual periodicity (occur in the same time of the year); triggers: alcohol, REM sleep
*more common in men, similar prevalence to MS
cluster headache treatment
abortive:
*SUBCUTANEOUS sumatriptan
*oxygen
stop the cluster bout:
*Galcanezumab
*Verapamil or lithium
*steroids
*occipital nerve blockers
secondary headaches
a headache that reflects extracranial or intracranial conditions that may be severe or life-threatening
trigeminal neuralgia
*frequent short bursts of pain in the trigeminal distribution (V2 or V3 most common)
*triggers: light touch, air
* > 50 years old
giant cell (temporal) arteritis
*caused by granulomatous inflammation of large facial arteries (vasculitis of medium and large vessels in the head)
*age > 55 yo, women
*s/s: headache, bitemporal tenderness, pain with chewing (jaw claudication)
*progresses to blindness
*dx: ESR, CRP, CBC, BIOPSY OF TEMPORAL ARTERY
*start steroids IMMEDIATELY if you suspect it
increased intracranial pressure & secondary headache
*s/s: papilledema, awakens in the middle of night, projectile vomiting, cough headache
*causes: brain tumor or high CSF pressure headache
idiopathic intracranial hypertension (pseudotumor cerebri)
*overweight women + headache + visual + papilledema
*MRI (exclude brain tumor or venous thrombosis)
*elevated LP opening pressure is diagnostic
*treatment: weight loss, diuretics
low pressure headache / CSF leak
*positional headache (laying down good vs sitting up severe)
*most common cause = iatrogenic (from lumbar puncture)
*MRA with contrast: pachymeningeal enhancement
*sagging brain/cerebellum
