Headache 3 Flashcards
Tension type headaches (TTH) are also known as….
muscle contraction headaches
Describe the clinical features of a TTH
Site: symmetrical - frontal, over forehead and temples.
Quality: Dull ache, ‘tight pressure feeling’, ‘heavy weight on top of head’
Describe Associated Features of TTH
Lightheadedness Fatigue Neck ache and stiffness (occiput and shoulders) Perfectionist personality? Anxiety / depression
Describe what you would find on physical examination in TTH
Normal neuro exam
Evidence of muscle tension
Scalp may be tender
Palpation: not isolated segmental pain generator (C0-C3)
What is the IHS criteria for TTH?
10x + HA
30mins - 7 Days
. Must have at least 2 of 4 Non-pulsating quality Mild or moderate intensity Bilateral location No aggravation with routine physical activity
No nausea or vomiting
No photophobia or phonophobia (or just one)
Less than half month and half the year
How would you manage TTH
Education postural, Stress management, OMT , Medication, lifestyle modification
Which type of migraine has an aura present?
Classic migraine
Describe the clinical features of a Classic migraine
Temporofrontal region – unilateral or bilateral
Radiation
Retro-orbital and occipital
Quality
Intense and throbbing
Frequency
1 to 2 per month
Duration
4 to 72 hours – typical is 6-8 hours (“a day”)
Onset
Sudden recurrence
May wake up with it
Offset
Spontaneous – often after sleeping
Precipitating factors Tension and stress (common) Known triggers – endogenous and exogenous Aggravating factors Tension, activity
Relieving factors
Sleep, vomiting
Associated factors
Irritability
Aura- visual (scintillating scotoma, hemianopia, fortification); sensory (unilateral paresthesia)
Describe exogenous and endogenous migraine trigger factors
Exogenous - “HEDGES”
Head trauma – minor eg jarring Exercise Drugs – vasodilators, oestrogens, MSG, nitrites (‘hot dog HA’), OCP Glare / bright light Excessive noise Strong perfume Endogenous - " Hunger Emotional stress Stress Tiredness
What is the IHS Criteria for classic migraine
Happened at least twice
gradual development over 40 mins
Aura duration less than 60minutes
HA follows aura in less than 60 mins
What is the I.H.S Criteria for common migraine
- Patient should have had at least 5 of these HA’s
- The HA’s last 4-72 hrs
- Must have 2 of 4
Unilateral location
Pulsing quality
Moderate or severe intensity, inhibiting or prohibiting activities
HA worsened by routine physical activity - HA must have at least 2 of the following
Nausea and/or vomiting
Photophobia and phonophobia
How would you manage migraines?
Education - triggers, explanation and reassurance, medication
How do you treat an acute attack migraine.
Medication, Dark room, peace and quite, rest
Describe the Clinical Features of Cluster HA
Site
Unilateral
Located periorbitally and/or temporally
Quality:
Intense pain
Frequency:
Occurrs up to 8 times per day
in bouts lasting weeks or months
Duration:
Headache that lasts 15 - 3hrs
Associated symptoms: Tearing Red eye Stuffy nose Facial sweating Ptosis Miosis
Define concussion
as a traumatically induced physiologic disruption in brain function that is manifested by loss of consciousness, memory loss, alteration of mental state or personality, or focal neurologic deficits
