Headache Flashcards
What are the two main classifications of headaches?
Primary headaches and secondary headaches.
What are the primary types of headaches?
Migraine, tension-type headache, trigeminal autonomic cephalalgias, and other primary headaches.
What are the secondary types of headaches?
Headaches attributed to trauma, vascular disorders, infections, substance withdrawal, homeostasis disorders, and psychiatric conditions.
What is the most common primary headache?
Tension-type headache (TTH).
What is the pathophysiology of headaches?
Activation of pain-sensitive structures in the head, mediated by the trigeminal and upper cervical nerves.
What neurotransmitters play a role in headache pain transmission?
Glutamate, substance P, calcitonin gene-related peptide (CGRP), and neurokinin A.
What are the diagnostic criteria for migraine?
Headache lasting 4-72 hours with at least 2 of the following: unilateral location, pulsating quality, moderate/severe intensity, or worsening with physical activity. Plus nausea/vomiting or photophobia/phonophobia.
What is the difference between migraine with and without aura?
Migraine with aura includes transient neurological symptoms (e.g., visual disturbances) before headache onset, while migraine without aura lacks these symptoms.
What are common migraine triggers?
Stress, altered sleep patterns, skipping meals, bright lights, hormonal changes, alcohol, and certain foods.
What is the first-line symptomatic treatment for migraine?
NSAIDs (naproxen, diclofenac), acetaminophen, and triptans (sumatriptan, zolmitriptan).
What is the mechanism of action of triptans?
Selective 5-HT1B/1D receptor agonists that constrict intracranial vessels and inhibit pain pathways.
What are the prophylactic treatment options for migraine?
Beta-blockers (propranolol), antiepileptics (valproate, topiramate), antidepressants (amitriptyline), and CGRP monoclonal antibodies (erenumab, fremanezumab).
What is status migrainosus?
A severe migraine attack lasting more than 72 hours, requiring medical intervention.
What is a tension-type headache (TTH)?
A headache with a bilateral, pressing or tightening quality, mild to moderate intensity, and not aggravated by routine activity.
How is episodic TTH different from chronic TTH?
Episodic TTH occurs less than 15 days per month, while chronic TTH occurs at least 15 days per month for more than 3 months.
What are effective treatments for tension-type headaches?
Simple analgesics (acetaminophen, aspirin, NSAIDs) and stress management techniques.
Why are opioids not recommended for TTH?
Risk of medication overuse headache and dependency.
What are trigeminal autonomic cephalalgias?
Strictly unilateral headaches with prominent autonomic symptoms (lacrimation, rhinorrhea, ptosis, conjunctival injection).
What are examples of trigeminal autonomic cephalalgias?
Cluster headache, paroxysmal hemicrania, SUNCT (short-lasting unilateral neuralgiform headache with conjunctival injection and tearing), and SUNA.
What is a cluster headache?
A severe unilateral headache lasting 15-180 minutes, occurring in clusters over weeks to months, with autonomic symptoms.
What are the characteristic symptoms of cluster headache?
Severe orbital pain, lacrimation, nasal congestion, conjunctival injection, and ptosis on the affected side.
What are the diagnostic criteria for cluster headaches?
Severe unilateral orbital, supraorbital, or temporal pain lasting 15-180 minutes, with at least one autonomic symptom.
What is the first-line acute treatment for cluster headache?
Subcutaneous sumatriptan and high-flow oxygen therapy.
What is the first-line prophylactic treatment for cluster headache?
Verapamil, with ECG monitoring due to potential cardiac effects.
What is hemicrania continua?
A chronic unilateral headache with continuous pain and superimposed exacerbations, responsive to indomethacin.
What are secondary headaches?
Headaches caused by an underlying medical condition, such as trauma, infection, or vascular disease.
What are red flags for secondary headaches?
Sudden onset, worst headache ever, progressive headache, new headache in patients over 50, headache with systemic illness, headache triggered by exertion or Valsalva maneuver.
What serious conditions can present with headache?
Subarachnoid hemorrhage, brain tumor, temporal arteritis, meningitis, and idiopathic intracranial hypertension.
What is the classic presentation of subarachnoid hemorrhage?
Sudden severe ‘thunderclap’ headache, often described as the worst headache of the patient’s life.
What is idiopathic intracranial hypertension (pseudotumor cerebri)?
Increased intracranial pressure without an identifiable cause, often in young obese women, presenting with headache, papilledema, and visual disturbances.
What is the first-line treatment for idiopathic intracranial hypertension?
Acetazolamide and weight loss.
What is temporal arteritis (giant cell arteritis)?
A vasculitis affecting large arteries, causing temporal headaches, jaw claudication, and vision loss.
What is the diagnostic test for temporal arteritis?
Elevated ESR and temporal artery biopsy.
What is the treatment for temporal arteritis?
High-dose corticosteroids to prevent vision loss.
What is a medication-overuse headache?
A chronic headache caused by frequent use of analgesics (NSAIDs, opioids, triptans).
What is a primary exertional headache?
A headache triggered by strenuous physical activity, typically benign but requiring evaluation to rule out secondary causes.
What is primary thunderclap headache?
A severe headache reaching peak intensity within seconds, requiring urgent evaluation for subarachnoid hemorrhage.
What is a hypnic headache?
A rare headache that occurs exclusively during sleep, typically in older adults.
What are the treatment options for hypnic headache?
Caffeine before bedtime, lithium, or indomethacin.
What are the clinical features of headaches due to sinusitis?
Facial pain, pressure over sinuses, nasal congestion, and worsening with head movement.
How does meningitis-related headache present?
Severe headache with fever, neck stiffness, photophobia, and altered mental status.
What is the Kernig sign?
Inability to fully extend the knee when the hip is flexed at 90 degrees, indicating meningeal irritation.
What is the Brudzinski sign?
Involuntary hip and knee flexion when the neck is passively flexed, seen in meningitis.
How is a headache from brain tumors typically described?
Progressive, worse in the morning, associated with nausea, vomiting, and focal neurological deficits.
What imaging is recommended for new-onset severe headache with focal neurological signs?
MRI or CT scan of the brain.
What is the typical presentation of post-traumatic headache?
Persistent headache following head trauma, often resembling migraine or tension-type headache.
How does caffeine withdrawal cause headaches?
Caffeine withdrawal leads to rebound vasodilation, causing headache.
What lifestyle modifications help prevent chronic headaches?
Regular sleep, hydration, avoiding triggers, stress management, and limiting caffeine/alcohol intake.
