Headache 2 Flashcards
Severe HA, associated w/ nausea. HA began w/ severe eye pain.
PE = Eye is red with a fixed, moderately dilated pupil
Glaucoma
Acute, severe HA w/ stiff neck but NO fever suggests
Subarachnoid hemorrhage
Acute, severe HA w/ stiff neck AND fever suggests
Meningitis
Acute tx for migraine
Metoclopramide (dopamine antagonist)
Topiramate
Preventative tx for migraines
Amitriptyline, Botulism toxin type A
Preventative tx for migraines
Effexor
Preventative tx for migraines
Cells in the trigeminal nucleus activated during a migraine attack release?
Calcitonin gene-related peptide (vasoactive)
Half of pts w/ untreated temporal arteritis develop?
Blindness (d/t involvement of ophthalmic artery and its branches)
Begins few hrs after sleep onset. HAs last from 15-30 mins, usually moderately severe and generalized. (But can be UL and throbbing). Pts can fall back asleep to be awakened few hrs later by another attack. Up to 3 repetitions occur through the night. Daytime naps precipitate head pain. Mostly females > 60 y/o. Major contributor poorly controlled HTN 24 hr blood pressure monitoring to detect treatable condition
Hypnic HA
Sudden onset severe HA w/o any prior hx of HA. Next step?
Neuroimaging and LP
Tx of choice for hemicrania continua
Indomethacin (100 mg IM)
70 y/o F presents w/ severe HA, scalp tenderness, and mild fever. She has polymyalgia rheumatica and jaw claudication. Nxt step?
Biopsy and prendisone therapy
*Temporal arteritis
Involves extracranial carotid circulation.
HA, polymyalgia rheumatica, jaw claudication, fever, and weight loss. HA is dominant sx and explosive in onset, dull and boring pain, with superimposed sharp (stabbing) pains. Pts can recognize origin of pain is superficial, external to skull. Scalp tenderness is present. HA worse at night. Aggravated by exposure to cold.
Temporal (giant) cell arteritis
Cluster HA frequency
0.1%
Deep pain, retro-ortbital. Excruciating, non-fluctuating, and explosive. At least one of the daily attacks recurs at about the same hr each day for the duration of a cluster bout. Usual pt has 1-2 attacks of short-duration UL pain for 8-10 wks per yr
Cluster HAs
Gender in which cluster HAs are more common
men
Associated with ipsilateral sxs of cranial parasympathetic autonomic activation
cluster HAs
Severe pain behind her right eye w/ lacrimation and nasal congestion on same side lasting 3 mins. 6-8 attacks per day, resolves after 2 days. Excellent response to indomethacin. Dx?
Paroxysmal hemicrania
Frequent, UL, severe, short episodes of HA. Pain tends to be retro-ortbital, but may also be experienced all over the head, and associated w/ autonomic phenomena (lacrimation and congestion). Short lasting attacks (2-45 mins). Very frequent (>5 daily attacks). Rapid course (<72 hrs). Excellent response to indomethacin
Paroxysmal hemicrania
BL, tight, band-liek discomfort across forehead. Building slow pain, fluctuating in severity, persisting for several days
Tension HA
BL, throbbing HAs lasting 30-45 mins, precipitated by jogging and worsened by exertion. Dx?
Exertional HA
Features resembling both cough HA and migraine
Exertional HA
Can be precipitated by any form of exercise. Pulsatile quality of migraine. Pain BL and throbbing at onset. Prevented by avoiding excessive exertion, esp. in hot weather or at high altitude
Exertional HA
Dull, BL ache in head and neck that intensifies during sexual intercourse. Dx?
Primary sex HA
Dull BL ache in head and neck that intensifies as sexual excitement increases; Sudden, severe, explosive HA occurring at orgasm; Postural HA developing after coitus that resembles HA of low CSF pressure
Types of primary sex HAs
Can be precipitated by sexual intercourse. Suspect if HA starts at orgasm
Subarachnoid hemorrhage
HAs that begin suddenly, lasts several mins - few hrs, and precipitated by coughing
Primary cough HA
Generalized HA that begins suddenly, lasts for several mins up to few hrs, precipitated by coughing
Primary cough HA
Serious etiologies must be excluded before coming to this dx
Primary cough HA
Chiari malformation or any lesion causing obstruction of CSF pathways or displacing cerebral structures can cause
head pain
Cerebral aneursysm, carotid stenosis, and vertebrobasilar disease can present with
Cough or exertional HA
