Headache Flashcards
Recognize the epidemiological implications of headache
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Know the difference between a primary and secondary headache syndrome
- Primary headaches have no underlying pathology and are usually recurrent (90% of HAs)
- Secondary headaches are associated with underlying pathology or a systemic disorder and are constant (10% of HAs)
How do you recognize a Migraine?
At least 5 recurring headaches lasting 4-72 hours.
Two out of: Unilateral, Pulsating, Mod-severe intensity, Increases with physical activity
One of: Nasea, Vomiting, Photophobia, Phonophobia
Four phases
Triggers may include missed meals, lack of sleep, alcohol, caffeine withdrawl, foods
How do you recognize a Tension type headache?
- At least 10 episodes of HA lasting 30m.-7d.
- Each episode is characterized by bilateral tightening sensation of mild-mod. severity.
- Not aggravated by activity.
- No n/v
- +/- photophobia or phonophobia (but not both)
How do you recognize Cluster headache syndrome?
At least 5 episodes of SEVERE, unilateral, peri-orbital and/or temporal pain lasting 15-18 min
Recur at least every other day up to 8x/day.
Includes one of the following: Conjunctival injection, lacrimation, nasal congestion, rhinorrhea, eyelid edema, ptosis, miosis, facial swelling, restlessness.
More common in men
Triggers: alcohol, drugs (due to vasodilatation)
Describe Meningitis
Acute onset
Fever, neck stiffness, n/v, altered consciousness, signs of meningeal irritation (Kernig’s sign and Brudzinski’s neck sign in children)
LP: elevated WBCs, nl to low glucose, nl to elevated protein
Describe Traumatic injury to the head
HA pain develops in 7d. and resolves in 3mon.
Dizziness, poor concentration, irritability, and insomnia
(may be labeled as secondary migraine)
Describe Subarachnoid hemorrhage
Most common cause of sudden headache
Diffuse pain, stiff neck, photophobia, n/v, neurologic findings, obtundation
CT shows blood (best within 12h)
LP (best after 12h): xanthochromia and RBCs
Most often due to trauma or ruptured aneurysm
Describe Giant cell arteritis
8th or 9th decade of life
Very painful, jaw claudication, temporal a. region scalp tenderness, visual loss, joint pain, and constitutional sx.
Elevated ESR and C-reactive protein
Diagnosed with temporal a. biopsy
80% incidence of blindness if untreated
Describe Idiopathic intracranial hypertension
More common in women, often in obese women
HA worse with activity and when waking
Retrobulbar pain, n/v, pulsatile intracranial noises, visual obscurations/photopsias/diplopia/vision loss, papilledema
CN VI palsies
Normal CSF
What is the appropriate clinical evaluation and treatment options for a migraine headache?
Evaluation via history or signs/symptoms
Treatment:
Prophylactic tx: beta blockers, calcium channel blockers, tricyclic antidepressants, anti-epileptics
Abortive tx: aspirin, acetaminophen, NSAIDs, and combos of these with caffeine, TRIPTANS
Alternative tx: SLEEP!, Vit B2 (riboflavin), acupuncture and biofeedback
What is the appropriate clinical evaluation and treatment options for Subarachnoid hemorrhage?
Evaluation:
CT is 100% sensitive in first 12 hours, decreases to 93% in 12-24 hours
LP is most sensitive at 12 hours
Cerebral angiography to confirm aneurysm presence/AVM
Treatment is surgery (interventional radiology)
What is the appropriate clinical evaluation and treatment options for Giant cell arteritis?
Evaluation:
Elevated ESR and C-reactive protein
Temporal a. biopsy
Treatment is corticosteroids
