Headache Flashcards
essential questions to ask about a h/a to rule in or out a migraine.
- Has a headache limited your activities for a day or more in the last 3 months?
- Are you nauseated or sick to your stomach when you have a headache?
- Does light bother you when you have headache?
Migraine headache is located unilateral or bilateral
unilateral
Charactereistics of a migraine H/A
Gradual in onset, crescendo pattern; pulsating; moderate or severe intensity;
What type of H/A is aggravated by physical activity
Migraine
pt. prefers to be in dark quite room with which type of H/A
Migraine
How long can a migraine last
4-72 hours
what are associated symptoms with migraines
- N/V
- Photophobia
- Phonophobia
- Aura
What type of H/A is bilateral
Tension
Tension H/A charteristics
Pressure or tightness which waxes and wanes
Duration of a tension h/A
variable
Associated symptoms with a tension H/A
none
what type of H/A is
Always unilateral, usually begins around the eye or temple
Cluster
Characteristics of a cluster H/A
Pain begins quickly, reaches a crescendo within minutes; pain is deep, continuous, excruciating, and explosive in quality
How active is a person with a cluster H/A
remain active
Cluster H/A last about
30 mins to 3 hours
associated symptoms of a cluster H/A
redness of the eye; stuffy nose; rhinorrhea; pallor; sweating; Horner's syndrome; focal neurologic symptoms rare; sensitivity to alcohol
H/A triggers
many from diet to stress to changes in the environment
Danger signs with a H/A
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
Danger signs with physical exam and a H/A
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.
primary H/A cause
vascular
brain stem
inflammation of the vessels or meninges
secondary H/A cause
Structural or physiological pathology Lesions: Metabolic: Vascular Meningeal:
what can abort a H/A
serotonin agonists (triptans) work to abort H/A , ergots also bind to these sites.
describe a Migraine with out Aura
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
Describe a migraine with Aura
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
Describe a cluster H/A
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.
signs of a
Subarachnoid Hemorrhage
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
signs of Post traumatic H/A
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
signs of giant cell
Arteritis
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)
Giant Cell Arteritis‐ Diagnostics:
CBC
– Mild to moderate normochromic/normocytic anemia – Elevated platelet count
Westergren ESR > 50mm/hr
temporalarterybxw/vasculitis & nonnuclear cell infiltrate or granulomatous changes
