Headache Flashcards
What is the difference between a primary and a secondary headache?
Primary - headache is primary problem (tension, cluster)
Secondary - headache is secondary to mass, etc
What are the typical Sx of migraine headache?
Throbbing pain, associated nausea and vomiting; commonly an aura
What is the pathophysiology of migraine headache?
Cortical spreading depression affects parts of cortex 2-3 mm/min, activates trigeminal afferents
What is the mainstay abortive therapy for migraines?
Triptans
What therapies should be offered for tension headaches?
Not many good ones, but avoid caffeine, NSAID overuse, etc to prevent rebound headaches
Described typical cluster headaches
Unilateral, accompanied by autonomic symptoms like lacrimal ion, eyelid edema, rhinorrhea
What treatments can be offered for cluster headache?
high flow oxygen, Triptans, steroids can shorten, avoid alcohol
What is paroxysmal hemicrania? How does it differ from cluster headaches?
Similar to cluster headaches except shorter in duration and greater frequency
Thunderclap headache is…
SAH
Headaches that improve when lying down are..
Low pressure headaches, usually iatrogenic (LP) but can be due to rupture of a CSF pouch
A patient has a headache worse in the morning with pulsatile tinnitus and visual obscurations (blurring of vision for a few seconds) this is…
Idiopathic intracranial hypertension
What is a possible complication of IIH?
Loss of vision from compress e optic neuropathy
What is the classic population of patients with IIH?
Young overweight women
An older patient presents with tender scalp, headache and jaw claudication. Think…
Temporal arteritis- tx with high dose steroids
What are the neurological causes of facial pain?
Trigeminal neuralgia, glossopharygeal neuralgia, post herpetic neuralgia
What is the treatment of choice for trigeminal neuralgia?
Carbamazepine or another anticonvulsant
What is the treatment of choice for post herpetic neuralgia?
Tricyclics, gabapentin
What is an Important mimic of IIH?
Venous sinus thrombosis
What tx options exist for IIH?
Carboni anhydrase inhibitors, optic nerve fenestration, repeated LP, limbo peritoneal shunting
What are ideal screening questions for migraine?
have headaches bothered you for >1 day in last 3 months
associated with nausea/vomiting?
worsened with light?
A patient presents with insomnia, lots of fatigue, emotionality etc. after a head trauma during driving. This is likely…
post concussive state
In what population of patients should triptans not be used?
people with heart disease, elderly
A patient presents with severe intermitten right sided cheek pain while brushing her teeth. This is..
trigeminal neuralgia
A patient presents with headaches for severeal years - she was just involved in a car accident in whch she hit the front of her head. CT shows a hyperdense left frontal parasagittal mass that enhances with contrast. This is..
meningioma
A 16 year old girl had wisdom tooth extraction and drainage of an abscess and presents with headache and fever with proptosis and erythema of the eyelid. This is..
cavernous sinus thrombosis
