Headache Flashcards
Migraine
Moderate to severe attacks of a pulsatile and unilateral quality, lasting 4-72 hours
- aura is kind of a migraine giveaway, but most do not have auras
- aggravated by activity
- at least one of the following: N/V, phono/photophobia
Spirochetal meningitis/aceptic/encephalitis (or viral encephalitis)
- elevated WBCs, increased proteins, normal glucose
- aseptic meningitis: really high protein
Migraine history criteria
- A history and physical and neurologic exam do not suggest a secondary cause
- Secondary cause present but headache not temporally associated with the disorder
Migraine with an aura
- not lasting more than 60 mins
- attacks follow aura with free interval of less than 60 mins
- at least one of the following: Exam does not suggest a secondary headache, Secondary headache suspected but ruled out by tests, Secondary headache disorder is present but headaches are not temporally associated with the disorder
Migraine trt
- eliminating triggers;caffeine, EtOH, stress
- triptans (sumatriptan, zolmitriptan, rizatriptan)
- ## 5HT agonism -> cerebral vasoconstriction
Triptans
- suma, zolmi, riza
- SE: flushing, chest tightness, dizziness (rare cardiac events)
- Cind: cardiovascular, cerebrovascular, periph. Vascular
- Interactions: SSRIs, CYP450
Tension headache criteria
Rule out migraine
Lack nausea and vomiting, photophobia and phonophobia are absent (one or the other)
Tension HA trt
Usually good response to over-the-counter analgesics
- Aspirin or acetaminophen in combination with caffeine and a short acting barbiturate
Cluster headaches
- Patients with cluster headaches cannot sit still or lie down and may prefer to sit or rock
- Pain is always unilateral on the same side for each attack
- Attacks may occur very regularly
- typical secondary HA rule out
Secondary HA: symptoms
- sudden onset “worst HA of my life”
- progressively
- stiff neck
- headache onset with exertion (valsalva)
- after age 50
- altered cognitive function
- abnormality on exam
Subarachnoid hemorrhage: diagnosis
- Unenhanced CT with LP to rule out
Arteritis
- sed rate indicator of inflammatory condition
- combined with fever, malaise, myalgias, visual loss, jaw claudication, and temporal artery tenderness
- high sed rate may indicate other pathologies (MM, malignancy, infection et al)
Venous thrombosis
- dural venous sinus
- usually progressive, drowsiness and lethargy develop, as well as focal signs of papilledema and coma
- preggers/oral contraceptive uses at higher risk
Meningitis
- developing HA, nuchal rigidity
- rapid administration of Abx is vital to good outcome
- must get CT and an LP (but trt empirically)
Intercranial neoplasms
- typically focal signs also present (seizure, cortical dysfunction )
- may be worse in the morning to sustained ICP from lying down all night
Benign intercranial HTN
- pseudotumor cerebri
- continuous headaches lasting weeks to months
- elevated opening pressure
- papilledema
- usually no other findings
- more common on obese 16-40 y/o females
Intercranial hypotension
- usually occur following LP
- present with standing, relieved by laying down
Cluster trt
- O2, subQ sumatriptan, nasal lidocaine
