headache Flashcards
red flags for headache?
SNOOP:
S: systemic symptoms (fever, weight loss)
N: neoplasm in hx (vomiting in morning with relief of headache)
N: neurological deficits (confusion, seizures)
O: onset if abrupt (SAH)
O: old age >50
P: positional headache and worse with valsalva (idiopathic intracranial HTN)
P: progressively worsens
P: papilledema and signs of high ICP
P: pregnancy (PE, pituitary apoplexy)
P: painkiller overuse at headache onset
tension headache clinical features and tx with prophylaxis?
dull, pressing, nonpulsating quality bilateral headache with no increase in intensity with exertion. Triggered by stress and lack of sleep. lasts more than 4 hours
tx: NSAIDs, acetaminophen, prophylaxis: amitriptyline (TCA)
migraine aura types? and headache features?
visual: scintillating scotoma (arch shaped scotoma start central then moves to periphery), central scotoma, flashing lights, fortification spectra (star-like)
sensory: aphasia, paresthesia, numbness
NO MOTOR SYMPTOMS otherwise its atypical. last for less than one hour
headache is unilateral, pulsating, frontal/retro-orbital, frontotemporal, worse with exertion, relived by sleep/spontaneously, lasts for 4-72 hours, associated with phonophobia, photophobia, NAUSEA and vomiting
migraine acute tx and prevention tx?
acute: IV fluids and anti-emetics if needed
mild to moderate headache (doesn’t severely affect daily routine): NSAIDs (ibuprofen, aspirin, diclofenac) or acetaminophen
moderate to severe headache (suspends daily routine): migraine-specific agents like sumatriptan OR ergotamine but never combine them. also antidopaminergics like metoclopramide
prevention:
first line: anticonvulsants (topiramate), BB (propranolol)
second line: TCA, riboflavin vit. B2, magnesium
start if >2 attacks a week, >2 attacks a month & disabling, cant use meds
paroxysmal hemicrania characteristic, duration, treatment?
unilateral periorbital pain that occurs many times a day and lasts 30 minutes associated with eye tearing, rhinorrhea, conjunctival injection.
no established tx for acute attacks
prevention: NSAIDs
SUNCT (short-lasting unilateral neuralgiform headache with conjunctival injection and tearing) characteristics, duration, treatment?
unilateral throbbing/burning/stabbing pain in temporal, orbital, supraorbital area lasting 30seconds-10 minutes. associated with rhinorrhea, conjunctival injection, tearing, eyelid edema. occurs once a day.
acute tx; IV lidocaine
prevention: anticonvulsants
cluster headache characteristics, duration, treatment?
agonizing, unilateral, periorbital, lasts 15min-3hrs, recurrent attacks at the same hr everyday and season every year (cluster periods), patients tend to walk around instead of rest during the attack. associated with conjunctival injection, tearing, rhinorrhea, partial horner (ptosis, miosis).
tx:
first line: 100% oxygen (cerebral vasoconstriction), triptans
prevention: verapamil
trigeminal neuralgia characteristics and tx?
unilateral paroxysmal stabbing (eleectric shock) pain followed by burning ache along trigeminal nerve distribution. triggered by talking chewing or touch. occurs many times in a day
acute tx: lidocaine
long-term: carbamazepine
