Headache Flashcards
how many people have experienced a HA in a 12 month period
90%
primary HA
migraine, tension type, cluster
secondary HA
head trauma, vascular, substance, metabolic, etc/
what does the headache exam look like>
general exam centered around the head and neck, neurologic centered around neurologic complaints and screening for occult path.
migraine without arua
at least five attacks with the following criteria:
- lasts 4-72 hr.
- at least two of these: unilateral, pulsating, moderate or severe intensity, aggravated with exertion.
- nausea/vomiting
- photophobia and phonophobia
prevalence
28 mil. 3X as many females. 25% of households have 1 migraineur. highest prevalence 25-55 age group.
phases of migraine
prodrome > aura > HA > resolution
aura
complex of focal neurologic symptoms (+/-) that precedes, accompanies or follows a migraine. these usually precede.
how common are aura
15% of migraines
how long is aura
5-20 min. less than 60,in
can the aura occur alone?
yes
most common type of aura
visual. paresthsias is second most common -the jacksonian march
diagnosis of migraine with aura
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.
tension type HA general comments concerning etiology
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.
episodic tension-type
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.
what is distinctly absent from tension-type
nausea and vomiting. photophobia and phono phobia are absent. one but not the other can be present.
medication overuse or rebound
occurs when taking symptomatic meds more than 3 days a week.. this can cause chronic daily HA.
what are the most common meds that cause rebound
caffeine/barbiturate containing meds and narcotics. tylenol, excedrin, Ibuprofen. specific migraine meds also cause rebound.
chronic daily HA syndrome
need to describe the HA episodic vs continuous. need to know what they take and how often -really.
cluster HA characteristic occurrences
clockwork and daily
who’s more likely to have a cluster?
men. 4:1. patients have typical heavy facial features called leonine features. masculine looking women. many patients are smokers.
what age of onset is common for cluster
27-31.
familial association with clusters?
14-39% fold increase if 1st degree relative
diagnosing cluster
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.
frequency of clusters
one attack everyday to 8 attacks per day.
thunder clap HA idiopathic
very severe pain intensity with hyper acute onset (<30sec). w/u will discount underlying cause.
symptomatic thunderclap
SAH, CVT, pituitary apoplexy, HTN crises, arterial dissection, spontaneous IC hypotension.
subarachnoid hemorrhage
severe HA that starts suddenly, some have a period of unresponsiveness, and focal signs.
how many patients have warning of SAH?
20-50% have a sentinel HA.
how common is SAH thunderclap?
10%. 90% are idiopathic thunderclap.
what else is associated with it?
70% vomit, 20% have had HA like that before. neck stiffness takes a while to develop.
how to diagnose SAH
CT is first step in wu. sensitivity 98% in first 12 hrs. must carefully scrutinize subtle changes.
SAH lumbar puncture.
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.
