Headache

Question 1

essential questions to ask about a h/a to rule in or out a migraine.

Answer 1

1. Has a headache limited your activities for a day or more in the last 3 months?
2. Are you nauseated or sick to your stomach when you have a headache?
3. Does light bother you when you have headache?

Question 2

Migraine headache is located unilateral or bilateral

Answer 2

unilateral

Question 3

Charactereistics of a migraine H/A

Answer 3

Gradual in onset, crescendo pattern; pulsating; moderate or severe intensity;

Question 4

What type of H/A is aggravated by physical activity

Answer 4

Migraine

Question 5

pt. prefers to be in dark quite room with which type of H/A

Answer 5

Migraine

Question 6

How long can a migraine last

Answer 6

4-72 hours

Question 7

what are associated symptoms with migraines

Answer 7

1. N/V
2. Photophobia
3. Phonophobia
4. Aura

Question 8

What type of H/A is bilateral

Answer 8

Tension

Question 9

Tension H/A charteristics

Answer 9

Pressure or tightness which waxes and wanes

Question 10

Duration of a tension h/A

Answer 10

variable

Question 11

Associated symptoms with a tension H/A

Answer 11

none

Question 12

what type of H/A is

Always unilateral, usually begins around the eye or temple

Answer 12

Cluster

Question 13

Characteristics of a cluster H/A

Answer 13

Pain begins quickly, reaches a crescendo within minutes; pain is deep, continuous, excruciating, and explosive in quality

Question 14

How active is a person with a cluster H/A

Answer 14

remain active

Question 15

Cluster H/A last about

Answer 15

30 mins to 3 hours

Question 16

associated symptoms of a cluster H/A

Answer 16

redness of the eye; 
stuffy nose; 
rhinorrhea; 
pallor; sweating; 
Horner's syndrome; 
focal neurologic symptoms rare; 
sensitivity to alcohol

Question 17

H/A triggers

Answer 17

many from diet to stress to changes in the environment

Question 18

Danger signs with a H/A

Answer 18

Sudden onset of headache, or severe persistent headache that reaches maximal intensity within a few seconds or minutes after the onset of pain, warrants aggressive investigation
Change in mental status
fever with H/A

Question 19

Danger signs with physical exam and a H/A

Answer 19

Neck stiffness and especially meningismus (resistance to passive neck flexion) suggests meningitis.
Papilledema
Focal neurologic signs suggest an intracranial mass lesion, arteriovenous malformation, or collagen vascular disease.

Question 20

primary H/A cause

Answer 20

vascular
brain stem
inflammation of the vessels or meninges

Question 21

secondary H/A cause

Answer 21

Structural or physiological pathology 
Lesions:
Metabolic:
Vascular
Meningeal:

Question 22

what can abort a H/A

Answer 22

serotonin agonists (triptans) work to abort H/A , ergots also bind to these sites.

Question 23

describe a Migraine with out Aura

Answer 23

Headache Descriptions (Any 2)
Associated Symptoms (Any 1)
•Unilateral
•Pulsatile quality
•Moderate to severe pain intensity
•Aggravation by or causing avoidance of routine physical activity
•Nausea and/or vomiting •Photophobia and phonophobia
*Must have 5 attacks fulfilling the above criteria and no signs of a secondary headache disorder.
The headaches last 4–72 hours

Question 24

Describe a migraine with Aura

Answer 24

At least 2 attacks fulfilling criteria B
B
Aura consisting of at least one of the following, but no motor weakness: •Fully reversible visual symptoms including positive features (e.g., flickering lights, spots, or lines) and/or negative features (i.e., loss of vision)
•Fully reversible sensory symptoms including positive features (i.e., pins and needles) and/or negative features (i.e., numbness)
•Fully reversible dysphasic speech disturbance
C
At least two of the following:
•Homonymous visual symptoms and/or unilateral sensory symptoms
•At least one aura symptom develops gradually 5 minutes or more and/or different aura symptoms occur in succession over 5 or more minutes
D
Headache fulfilling criteria for migraine without aura beginning during the aura or follows the aura within 60 minutes

Question 25

Describe a cluster H/A

Answer 25

Headache Description (All 4)
Autonomic Symptoms (Any 2)
•Severe headache
•Unilateral
•Duration of 15–180 min •Orbital, periorbital, or temporal location
•Rhinorrhea
•Lacrimation
•Facial sweating
•Miosis (pupil constriction) •Eyelid edema •Conjunctival injection •Ptosis
*No evidence of a secondary headache disorder. Episodic cluster headaches occur for 1 year.

Question 26

signs of a

Subarachnoid Hemorrhage

Answer 26

udden onset, any time
– Maximum intensity in a few minutes
– “Thunder‐clap” HA “ first & worst”
– Subtle neuro changes – brief LOC at onset, ocular motor nerve palsy, papilledema

Question 27

signs of Post traumatic H/A

Answer 27

Chronic non‐specific HA in 30‐50%
– Dizzy, irritable, fatigue, insomnia
– Impaired concentration, memory disturbance – Months to 18 months ( lifetime)
– Dx. Neuro exam is WNL

Question 28

signs of giant cell

Arteritis

Answer 28

New onset, localized HA
– Temporal artery tenderness or decreased pulse
– Polymyalgia syndrome (aching & stiffness of trunk & proximal
muscle groups
– Scalp tenderness, malaise, anorexia, mild fever, jaw
claudication, or throat pain
– Temporary visual changes include blurring, diplopia,
amaurosis fugax (transient unilateral blindness)

Question 29

Giant Cell Arteritis‐ Diagnostics:

Answer 29

CBC
– Mild to moderate normochromic/normocytic anemia – Elevated platelet count
Westergren ESR > 50mm/hr
temporalarterybxw/vasculitis & nonnuclear cell infiltrate or granulomatous changes