Headache Flashcards
What HA are more common in males
Cluster
What HA are more common in females
migrain, tension, trigeminal neuralga, medication overuse, TMJ more painful
How are TBIs gradded
TBI gradded by loss of conciousness
Why should TBI pts be monitered
for secondary injury, brain swelling
What percent of pop seeks medical attention for HA
5-10 percent
what is the classification of migraine
vascular primary
what is the classification of tension type HA
non vascular primar
what is the class of cluster HA
vascular primary
what is the first and second most common HA
migrain is first and tension is second
what are the major indicatiors of migraine?
photophobia, nausea, limiting of activities
what is an aura?
scintilating scotoma, photopsia, farethesia on face, numbness, unilateral weakness, olfactory hallucination and aphasia
what medical conditions are associated with migrain?
tourettes, epilepsy, asthma, raynauds, hypertension
What triggers a migrain?
stress, hormones, change of sleep, weather, food intolerances and tyramine food.
What workup would you do for migraine?
EEG, EMG, Xray cervical, CT, MRI, TMJ, CMP
Where are migranes located?
Unilaterally mostly in the <50
What are red flags for HA PE?
Feaver, neck stiffness, papilledema, Focal neurological signs, systemic illness signs
What does papilledema indicate?
meningitis, mass, increased pressure
what would feaver indicate?
systemic, intercranial or local infection
What are history red flags?
onset after 50, first/worst, TBI, HIV, Cancer, Mental status change, sudden onset. Pain moves to spine.
Prodrome for migraine?
food craving, fatigue, heightened perception, fluid retention
How does a migrain resolve
sleep, vomiting, etc.
what type of migrain is an emergency?
opthalmoplegic of CN III VI VI - parylysis
what are the three classifications of tension HA
infrequent 1/month, frequent 14/month, chronic 15 or more/month
what is a trigger for a tension headache?
stress
how long does tension HA pain last?
30 minutes to 7 days, very irregular
How long does migain last?
4 to 72 hours
How long does cluster HA last
30 minutes to 3 hours, but multiple times each day
where are tenson HA
bilateral with a steady moderate intensity that doesn’ stop daily activities.
Why are cluster and trigeminal nuralga so dangerous
because the pain is so awful it can cause suicide
what is a trigger for a cluster headache?
the season
what is the trigger for a Trigeminal neuralgia
touching cheek, chewing, yawning, wind, very mild stuff
what are the two cluster HA possibilities
Episodic, less than 1 year to chronic, more than 1 year withno remission
where are cluster HA?
unilateral in middle aged men
what is the pain of a cluster headache like?
constant searing pain.
can a pt remain active with a cluster headache
yes
what are som other symptoms of cluster HA
tearing, redness of eye, sweating, sensitivity to alcohol,
What causes trigeminal neuralga
compression of trigeminal nerve root by artery or vein
what type of pain is trigeminal neuragia?
lightening like, lasting for fraction of second to 2 minutes on the right side
when would you do CT or MRI on trigeminal neuralga HA patient
if there is trigeminal sensory loss, bilateral symptoms, and if they are under 40 yo
who would get a medication overuse headache
mostly women who have a history of chronic HA and frequenly use analgesics.
what type of headache is the medication HA ususally
migrain or tension type.
what would medicaiton overuse headache DDX
migrain, ttHA, chronic rhinosinusitus, intracranial pathology
How often is the rebound/overuse HA
daily and worse ofter physical exertion
what types of things cause dietary headaches
nitrates, MSG, nutrasweet, alcohol, hypoglycemia
what is the triad that indicates meningitis?
nuchal rigidity, change in mental status, feaver, and looking really sick.
what 4 exams can be used to indicate meningitis?
Fundoscopic, mental status, Kernig sign guard hamstring, and brudzinski to flex him if straiten neck.
what causes meningitis
fungal, bacterial or viral infection
type of HA with meningitis
throbbing and very severe
in addition to the triad, what else would you look for in meningitis
a rash in later stages
what may cause meningitis like symptoms
sinus headache, and dental pain
how is meningitis diagnosed?
lumbar puncture, blood culture and gram stain
what are the three bloodpressure related headaches?
Hypertension HE, intracranial hypertension and intracranial hypotension
Hypertension HE is from what
sudden severe increase in BP sometime accopanied by tinnitus, epistaxis and bruits in carotids
What would cause intracranial hypertension?
edema or tumors.
what is a sign of intracranial hypetension
mild HA for less than 3 hours that is worse when lying down, it gets worse and more frequent
what exam may detect intracranial hypertension
fundoscopic looking for papelledema
when should you RO for headache, hypertension
aura persists after HA, change in HA pattern, epilepsy onset after 20
what is a cause of intracranial hypotension
iatrogenic, lumbar puncture
when is intracranial hypotension HA worse
HA worse when sitting up.
how does the pain of HA differ between intracranial hypotension and giant cell arteritis
they are opposite, hypotension is worse when sitting, Giantcell is worse when laying down.
example of an intracranial mass that causes headaches
pituitary tumor compressing sella tursica
signs of pituitor tumor
pain is referred bilaterally to frontal, temoral or occiput. Eventually causing vision problems on one or both sides.
what is an associated sign of pituitory tumor
pituitory hormone deficit.
how is a pituitary tumor detected?
CT or MRI
what is giant cell arteritis?
chronic inflammation of large and medium sized vessels causing temporal, occiput or frontal head pain.
when does gian cell arteritis occur
mean age is 72 so in elderly who smoke.
where does giant cell arteritis HA occur
one or both sides and it causes tenderness on surface of scalp
associated symtopms of gian cell
fever, anorexia, vision loss, polymyalgia rheumatic (muscle joint pain) and chronic non productive cough.
What would you discover with Giant cell arteritis upon PE
nodules over arteries, tenderness of artery and absent pulse.
What would labs find for gian cell?
increase in inflammatory markers, ESR, CRP, CBC more leuckocytes, Liver enzymes, less serum albumen
how would giant cell arteritis get diagnosed?
arterial biopsy
why is giant cell arteritis dangerous
blindness, stroke, aneurism, MI, arterial indufficiency
what could indicate a subarachnoid hemorrhage
sudden followed by persistent intense HA, worse and worsening.
How is subdural hematoma different from subarachnoid hemorrhage
onset is gradual with steady aching , personality changes, and altered conciousnesses.
What can cause TMJ
malposition, arthritis, inflammation or whiplash
Where is TMJ HA pain
tenderness in jaw muscles, radiate to ear, hard to open, clicking.
what is bruxism
teeth grinding
how can you test for TMJ
see of 3 fingers stacked fit in mouth. Feel for popping or look for midline deviation.
depressive headaches are like what
very vague and generalized
what can cause eyepain HA
near or far sightedness, mal alignment of eyes, glaucoma, or conjunctivitis.
how does one test for strabismus, or mal alignment of eyes
corneal light reflex
