Headache Flashcards

1
Q

how many people have experienced a HA in a 12 month period

A

90%

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2
Q

primary HA

A

migraine, tension type, cluster

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3
Q

secondary HA

A

head trauma, vascular, substance, metabolic, etc/

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4
Q

what does the headache exam look like>

A

general exam centered around the head and neck, neurologic centered around neurologic complaints and screening for occult path.

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5
Q

migraine without arua

A

at least five attacks with the following criteria:

  1. lasts 4-72 hr.
  2. at least two of these: unilateral, pulsating, moderate or severe intensity, aggravated with exertion.
  3. nausea/vomiting
  4. photophobia and phonophobia
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6
Q

prevalence

A

28 mil. 3X as many females. 25% of households have 1 migraineur. highest prevalence 25-55 age group.

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7
Q

phases of migraine

A

prodrome > aura > HA > resolution

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8
Q

aura

A

complex of focal neurologic symptoms (+/-) that precedes, accompanies or follows a migraine. these usually precede.

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9
Q

how common are aura

A

15% of migraines

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10
Q

how long is aura

A

5-20 min. less than 60,in

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11
Q

can the aura occur alone?

A

yes

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12
Q

most common type of aura

A

visual. paresthsias is second most common -the jacksonian march

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13
Q

diagnosis of migraine with aura

A

at least two attacks with the HA lasts 4-72 hr.
additionally…
2. at least three of these:
one or more fully reversible aura symptoms indicating focal cerebral cortical and or brainstem dysfunction.
at least 1 aura symptom develops gradually over more than 4 min. or they can occur in succession.
no aura last more than 60 min. multiple following each other can extend the time.
HA follows aura with interval of less than 60 min.

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14
Q

tension type HA general comments concerning etiology

A

strong evidence that muscle contraction has nothing to do with it. platelet GABA and 5HT are found dysregulated. there is no evidence of depression and anxiety.

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15
Q

episodic tension-type

A

at least 10 previous episodes fulfilling criteria. less than 180 days of the year.
HA lasts 30 min - 7 days.
at least two of: pressing/tightening non pulsating quality, mild-to-moderate intensity, bilateral, no exertional aggravation.

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16
Q

what is distinctly absent from tension-type

A

nausea and vomiting. photophobia and phono phobia are absent. one but not the other can be present.

17
Q

medication overuse or rebound

A

occurs when taking symptomatic meds more than 3 days a week.. this can cause chronic daily HA.

18
Q

what are the most common meds that cause rebound

A

caffeine/barbiturate containing meds and narcotics. tylenol, excedrin, Ibuprofen. specific migraine meds also cause rebound.

19
Q

chronic daily HA syndrome

A

need to describe the HA episodic vs continuous. need to know what they take and how often -really.

20
Q

cluster HA characteristic occurrences

A

clockwork and daily

21
Q

who’s more likely to have a cluster?

A

men. 4:1. patients have typical heavy facial features called leonine features. masculine looking women. many patients are smokers.

22
Q

what age of onset is common for cluster

A

27-31.

23
Q

familial association with clusters?

A

14-39% fold increase if 1st degree relative

24
Q

diagnosing cluster

A

at least 5 attacks.
criteria: severe unilateral orbital, supraorbital, and/or temporal pain lasting 15-180 min.
associated with at least one of these signs on the pain side:
conjunctival injection, lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating, miosis, ptosis, eyelid edema.

25
Q

frequency of clusters

A

one attack everyday to 8 attacks per day.

26
Q

thunder clap HA idiopathic

A

very severe pain intensity with hyper acute onset (<30sec). w/u will discount underlying cause.

27
Q

symptomatic thunderclap

A

SAH, CVT, pituitary apoplexy, HTN crises, arterial dissection, spontaneous IC hypotension.

28
Q

subarachnoid hemorrhage

A

severe HA that starts suddenly, some have a period of unresponsiveness, and focal signs.

29
Q

how many patients have warning of SAH?

A

20-50% have a sentinel HA.

30
Q

how common is SAH thunderclap?

A

10%. 90% are idiopathic thunderclap.

31
Q

what else is associated with it?

A

70% vomit, 20% have had HA like that before. neck stiffness takes a while to develop.

32
Q

how to diagnose SAH

A

CT is first step in wu. sensitivity 98% in first 12 hrs. must carefully scrutinize subtle changes.

33
Q

SAH lumbar puncture.

A

required in all patients with neg CT. must wait 6-12 hours after HA onset. this is essential to detecting to xanthochromia. traumatic LP too common. opening pressure must be recorded as well.