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HEADACHE > HEADACHE > Flashcards

HEADACHE Flashcards

1
Q

90% of all Headaches are :

A

Primary, meaning they are not caused by any underlying disease or structural problem

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2
Q

Main Primary Headaches:

A

Migraine
Cluster Headache
Tension Headache

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3
Q

Cluster Headache: Description

The “ALARM CLOCK” Headache comes on in early morning or wakes its victim

A

-Acute Onset of Excruciating Stabbing PAIN!!!
Unilateral, usually around one eye

  • Drooping eyelid (Ptosis)
  • Meiosis (pupil constriction)
  • Tearing of that eye +/- Nasal Congestion

These folks kill themselves rather than endure this pain. QUICK!!! give them high flow O2!!!

-Last 30-90 Min & occur in clusters, multiple over one day/several days then remission for a few months

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4
Q

Cluster Headache Rx

A

High Flow O2

Give them a prescription so they always have it as these headaches come on fast. 10-15 min may abort the HA if used early.

Tryptans work but DONT USE TRYPTANS IN CAD - they constrict vasculature everywhere including the heart! Use Sumitriptan Sq Inj, works super fast, after or during O2 delivery.

Corticosteroids high then taper can help stop a cluster from perpetuating, not sure how

Add Verapamil during the cortico taper for prophylaxis (???) how this vasodilator helps control pain caused by vasodilation, I do not know but it is a treatment.

Lithium (???) this is due to Li’s use in treating cyclical BiPolar Disorder. Use it first line if you have a cluster HA pt who is also bipolar but not currently on Li.

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5
Q

Cluster Headache Rx, short form

A

High Flow 02
Sumitriptan SQ inn during 02 delivery
Script for Prednisone, high dose few days
with a Taper
Add oral Verapamil during taper for long term
prophylaxis.
Add Li to Verapamil if pt is also Bipolar.

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6
Q

Trigem Irritation and the Hypothalamus are involved in Cluster Headache and Substance “P” is released but the underlying cause remains unclear. Risk Factors:

A 
Stress
Extreme Temperature
Tobacco Use (smoking or chew)
Alcoholism
Male
Onset is 20-40
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7
Q

Migraine’s are caused by irritation of:

A

SENSORY NERVES

Eyes, Nose, Ears - over stimulation causes release of Substance “P” and Serotonin. The “P” leads to Histamine release (Inflammation) and the Serotonin causes vasodilation in the brain causing vessels to press on nerve tissue.

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8
Q

Most Common Cause of Med-Severe Recurrent Headaches

A

Migraine

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9
Q

Migraine Triggers

A

Red Wine
Chocolate
Aged Cheese
Flashing Lights
Strong Odors
Loud Sounds
Hormone Fluctuations (often premenstrual
as progesterone dives…. consider giving
progesterone if HA is premenstrual)
Stress
Sleep Deprivation

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10
Q

Area of visual disturbance

A

Scotoma: Zig Zag lines, geometric shapes
HAZY/FUZZY/Cloudy area of the vision field

All are associated with the migraine aura

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11
Q

Migrane Description

A

Unilateral HA that progresses to Pulsing then Throbbing and may eventually become generalized/Bilateral

  • often preceded by an aura
  • often w/photo phono Phobias
  • often w/ Nausea & Vomiting w/o GI cause
  • Might involve parasthesias
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12
Q

Abortive Migraine Meds

A

Caffeine + NSAID Combos OTC

Ketorulac (Toradol) Injection

Sumitriptan (Imitrex)- Do NOT use in CAD
constricts coronary arteries along with
those in the head.

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13
Q

Don’t Use SUMITRIPTAN In:

A

Coronary Artery Disease!!! it constricts vasculature , in the head (giving HA relief) and in the heart (causing MI…)

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14
Q

Abortive Migraine Drugs of LAST RESORT

A

Opiates

Always with an anti-emetic (Zofran/Reglan) AND
use the one with the NARCAN coating to prevent constipation.

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15
Q

Odansetron

A

Zofran
Anti-Emetic

Causes QT prolongation and Bradycardia so perhaps not with CHF/ Bradyarrythmias

5HT3 Serotonin Receptor Antagonist

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16
Q

Prophylactic Migraine Rx for more than 4 episodes of migraine:

A

Anticonvulsants: Depakote/Valproate
Topamax/ Topiramate

Propranalol may help if HTN/Stress is an inducer

Amitriptyline (TriCyclic) might kill two birds if your pt is also depressed - watch out for Suicide Risk and EKG changes

Maybe Verapamil - like for Cluster headaches

17
Q

Amitryptyline Warnings

A

Suicide Risk Increases

Its a Na+ Blocker so we get Seizures and
Ventricular Arrythmias like V-Tach/V-Fib and ST Elevations

18
Q

Prophylactic Behaviors for Migraine

A

SLEEP - get enough
HA Diary for dietary/environmental triggers
ID triggers and avoid them

Don’t overuse NSAIDs w/Caffeine - they can cause rebound headaches if overused.

Yoga/Stress Reduction by any alternative means that doesn’t give you headaches

19
Q

Tension Headache:

A

A “SQUEEZING” band around the head @ forehead level

Lasts 30 Min to several Days if untreated

Not light/sound/smell sensitive

Consider Neck Pain cause, TMJ, Stress/
Eye Strain

20
Q

Tension HA Rx

A 
Avoid Triggers (Stress...)
OTC NSAID (esp w/Caffeine)
Address poor posture/see chiropractor
21
Q

Unilateral Headache

A

Migraine or Cluster

Migraine has visual disturbance NV photophobia

Cluster is eye PAIN may cause unilateral tearing relieved by 02.

22
Q

Pain behind sinuses

A

Sinus Headache

Esp if w/ viral inf or URI

23
Q

Vice Like Pain, headband

A

Tension Headache

Give NSAIDs

Avoid Stressors

24
Q

Headache with loss of visual field (Pt fails the bunny ears test or it’s unequal)

A

Think Optic Chiasm Pressure
Think Pituitary or other tumor
Order CT scan of Head/Neck

25
Q

Headache and weigh loss…

A

Think cancer

Get CBC & follow up

26
Q

Headache w/ Fever

A

think Meningitis

Neck ROM, Kernig (leg) & Brudinski (bent knee/Neck Flexion)
-Strep Pneumo most common
-Neisseria Meningititis 2nd
-Head Trauma a good way for these normal
Flora to invade CSF
-Treat empirically w/Cephtriaxone until culture comes back unless the strep Pneumo in your area is Cefalo- Resistant, in which case use a quinine (great CSF penetration) and Vanco.

27
Q

Neonatal Meningitis bug

A

Group B Strep from mama’s vag. canal

Rx is Ampicillin + Gentamycin

Or… ensure Mama is tested @ 38 wks and labor and have her on Rx during labor/delivery

28
Q

Rx for Syphylitic Meningitis and Neisseria Meningiditis and non-resistant Strep Pneumo

A

Pennicillin G

29
Q

Listeria Meningitis is very deadly Rx?

A

Bactrim will do the trick if pt is penicillin allergic. Otherwise use Penn G.

30
Q

Best Quinilone for CSF penetration is

A

Moxifloxacin

Use it with Vanco to treat strep pneumo meningitis that is resistant to cephtriaxone and penicillin.

31
Q

Empiric Drugs for Meningitis

A

Cephtriaxone or
Carbapenem (big gun!)

(Moxifloxacin + Vanco for resistant strp pneumo)

32
Q

Headache AND need to lose weight?

A

Topomax

Now explain why…

HEADACHE (1 decks)

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