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Headache Flashcards

0
Q

Migraine pathophysiology?

A

cortical spreading depression/depolarizing wave
trigeminovascular system transmits the stimuli to pain (what is normal)
sensitization - nerves become hypesensitized so they have a higher magnitude of response (migraines) - tx ASAP
serotonin deficit

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1
Q

HA epidemiology?

A

90-95% are benign

1% are life threatening

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2
Q

Cluster pathophysiology?

A

activation of trigeminal -autonomic pathway

starts to tear

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3
Q

Tension HA pathophysiology?

A

start centrally
the common headache
CNS stimuli misinterpreted as pain
pain of the head muscles

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5
Q

Classification of headaches?

A

primary

secondary

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5
Q

Secondary HA - cx?

A 
systemic infxn (when you have a cold, dehydrated)
head injury*
vascular disorders*
subarachnoid hemorrhage*
brain tumor*
*rare
*underlying condition
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7
Q

Secondary HA - cx?

A 
systemic infxn (when you have a cold, dehydrated)
head injury*
vascular disorders*
subarachnoid hemorrhage*
brain tumor*
*rare
*underlying condition
pituitary adenoma
optic neuritis
temporal arteritis
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7
Q

Concerning exam?

A 
HTN, bradycardia, fever - LP (unless you can find the source)
papilledema (d/t ICP)
neck stiffness --> meningitis
focal neurologic finding --> CVA
ataxic gait
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8
Q

Concerning Hx?

A

“worst headache”
“thunderclap”-subarachnoid hemorrhage
onset of HA after 55yo (HA should be getting better)
recent change in pattern
HA w/ exertion (increased pressure –> aneurysm)
worsening despite tx
seeing holes/light/diplopia (abducens not working, glaucoma)

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9
Q

Common triggers of primary HA?

A

diet (caffeine)
stress
sleep
*finding trigger will help tx HA

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10
Q

Primary HA - tx?

A 
HA subtype
impact on ADL
response to tx
pt education (inherited? - control but will NEVER go away!)
avoid triggers
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11
Q

Primary HA - tx failures?

A

wrong dx
wrong medication
suboptimal dosing
unrealistic expectation (they expect to be “cured” but they’re not so they get frustrated!)

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12
Q

Migraine diagnosis?

A 
two of following:
unilateral pain
throbbing pain
aggravating w/ movement
mod/severe
one of the following:
N&V
photophobia
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13
Q

Migraine HA - sx?

A 
nasea
photophbia
lightheadnes
scalp tenderness
vomitting
visual disturbances 
prodromal and aura
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14
Q

When to use prophylaxis of MHA?

A

recurring MHAs that interfere w/ ADL
5+/mo
failing tx/contraindication
prevent neurologic damage: hemiplegic migraine, migrainous infarct

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15
Q

Preventative therapy for MHA?

A

ASA - CVA pts
Naproxen - little more effective
B Blockers (propranolol) - good w/anxiety but causes fatigue
TCA = tension + MHA
Valproate - prolonged HA, aytpical migraines

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16
Q

Pt education for prophylatic MHA?

A

meds take wks - must be tried for 3 mo before “failed tx”

start low and slow, effective? - taper down after 6mo

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17
Q

MHA tx?

A

ASAP
once it starts - it doesn’t stop! –> pain relief (keep them comfortable)
just sleep it off
r/o concerning hx & PE

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18
Q

abortive therapy for MHA-mild?

A

1) Naproxen (do not give to peds and preg)
2) Tylenol
* BENADRYL!- adjunct (helps them sleep

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19
Q

abortive therapy for MHA-mod?

A

1) Excedrin
2) Triptan (acts on 5HT receptors- cxs vasoconstriction: chest pains)
-Sumitriptan
-Rizatriptan
LAST RESORT: Ergotamines
AVOID: opioids (Codeine - cx rebound HA)
*BENADRYL!!
Dexamethasone - to avoid rebound

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20
Q

abortive therapy for MHA-severe?

A

1) Ketorlac
2) Sumitriptan (SQ); dopamine agonist - Metoclopramide, prochlorperzine, droperidol) + benadryl
LAST RESORT: ergotamines (dihydroergotoamine) - do not give if they had triptan
AVOID OPIOIDS - cx rebound HA
Dexamethasone to avoid rebound

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21
Q

Tension HA - classification?

A

infrequent (14days/mo)

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22
Q

Tension vs MHA?

A

same sx EXCEPT NO photophobia and N&V

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23
Q

Diagnostic cluster headaches?

A

trigeminal autonomic response - weeping

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24
Q

Tension HA - Tx?

A

1) ASA, naproxen, acetaminophen, caffeine combos
RESCUE: toradol, reglan + bendaryl
ADJACENT: Occipital nerve block, trigger point injection

lifestyle modification (less stress)
cognitive behavioral therapy

*TCA - amitryptiline (associated analgesic effect that is not found in SSRI)

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25
Q

Primary HA - categories?

A

tension
cluster
migraine

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26
Q

Cluster HA - tx?

A

PREVENTATIVE: verapamil (HD), lithium, topiramate + verapamil (to avoid HD), prednisone
ABORTIVE: O2, sumitriptan
ADJUNCT: glucocortioids (prednisone, dexamethasone)
SURGERY: trigeminal denervation, deep brain stimulation

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27
Q

HA hx to ask?

A
  • site
  • time/onset
  • response to tx
  • age
  • how many
  • birth control
  • head trauma
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28
Q

Time course - primary?

A

pattern

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29
Q

Time course - secondary?

A

NEW ONSET

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30
Q

Time course - migraine?

A

episodic

disabling

31
Q

Time course - cluster?

A

“clusters”

long inactive phases

32
Q

Time course - rebound?

A

daily breakthrough

requires rescue meds

33
Q

HA that is bilateral?

34
Q

HA that is unilateral, orbit, temple?

35
Q

HA that wax and wane?

36
Q

HA that is sudden

37
Q

HA that needs to be quiet in dark room?

A

migraine

tension

38
Q

HA that is variable in duration?

39
Q

HA that is 4-72 hrs long?

40
Q

HA that is 30-180 min long?

41
Q

HA that has photophobia and aura?

42
Q

HA that has tearing, stuffy nose, sweating?

43
Q

HA that is unilateral?

A

migraine

cluster

44
Q

HA that is unilateral, bifrontal?

45
Q

HA that has gradual onset?

46
Q

Pt has pain on the back of the head and upper neck; band like tightness?

47
Q

Tension HA - PE?

A

band like tension

back of the head and neck

48
Q

Tension HA - neurological?

49
Q

Which HA goes away w/ age?

A

tension

migraine

50
Q

MHA cx?

A 
stress
hormones (females)
not eating
weather/lights
family hx
51
Q

Prodromal?

A

24-48hrs before migraine
odd sensation (GI upset, behavioral changes, binge eating)
*time to take meds - ASAP tx for migraines

52
Q

Aura?

A

min - hrs before migraine
visual (spots, lights) aura - common
sensory (tingling)
motor and speech

53
Q

How long does MHA take?

resolve?

A

10-45min to start

resolves 4-72 hrs later

54
Q

How do children present w/ migraine?

A

abdominal - no HA just vomit

55
Q

Cluster HA - RF?

A

smoking (incr risk)

men

56
Q

Cluster HA - sx?

A 
quickly
no warning - peak w/in min
lasts from 30min-3hrs
ipsilateral redness, runny nose, weeping
moving around makes HA better
57
Q

Rebound/Withdrawal HA?

A

OD on drugs - side effect HA

58
Q

Rebound/withdrawal HA - sx?

59
Q

Rebound/withdrawal HA - tx?

A

wean off meds

60
Q

HA from tumor?

A

secondary

NEW HA - concerning for adults

61
Q

HA from tumor - sx?

A

vomiting d/t incr ICP (tumor takes up space in brain)
papilledema
no venous pulsation (eye exam)

62
Q

Concerning medical hx?

A

cancer

postpartum headache

63
Q

Increased ICP - sx?

A

blurry vision
diplopia (no venous pulsation, papilledema)
ataxia (cerebellar issues)

64
Q

Pseudotumor cerebri?

A

idiopathic

increased ICP

65
Q

Pseudotumor cerebri - population?

A

obese
female
20-40yo

66
Q

Pseudotumor cerebri - sx?

A

HA is worse w/ exertion (or anything that increases ICP)

papilledema in both eyes

67
Q

Pseudotumor cerebri is ruled in until…?

A

brain tumor is ruled out

68
Q

Pseudotumor cerebri - labs?

A

1) CT/MRI - r/o abscess/lesion of brain
2) LP to confirm ICP - CSF labs
* LP w/ brain abscess/lesion can cx hemorrhaging!!

69
Q

Pseudotumor cerebri- tx?

A

cont LP to release ICP

Acetazolamide

70
Q

Temporal arteritis?

A 
giant cell arteritis
near the ear
can cx hearing loss
vasculopathy
untreated = blindness
71
Q

Temporal arteritis - sx?

A 
sudden TEMPORAL HA
visual disturabance
systemically ill 
POLYMYALGIA RHEUMATIC SX (pain, stiffness)
jaw pain
72
Q

Temporal arteritis - labs?

A

ESR (systemic illness)

CRP

73
Q

Temporal arteritis - dx?

A

temporal artery bx

74
Q

Temporal arteritis - tx?

A

HD steroids

Neurology (13 decks)

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