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
reversible cerebral vasoconstriction syndrome (RCVS)
*recurrent thunderclap headaches
*segmental constriction of cerebral arteries (resolves by about 3 months)
*normal CSF protein
*must rule out subarachnoid blood, CNS vasculitis, cerebral venous thrombosis, cervical artery dissection
*consider precipitants: postpartum, vasoactive drugs, catecholamine tumors
thunderclap headache - standard protocol
1) head CT (looking for brain bleed)
2) if negative, lumbar puncture (look for blood, infection, and check opening pressure)
3) if negative, consider other causes
causes of thunderclap headache
*subarachnoid hemorrhage
*meningitis
*CSF leak
*vasculitis
*venous thrombosis
*arterial dissection
*pituitary apoplexy
*RCVS
CGRP & migraines
*CGRP is a protein released during migraine attacks
*dilates blood vessels, releases inflammatory molecules
*certain tx block the release of CGRP
