Headache Flashcards
Name 2 common triggers of cluster headaches.
- EtOH
- drugs w/ vasodilator properties
Name 4 general types of migraine prophylactic drugs.
- beta blockers
- calcium channel blockers
- tricyclic antidepressants
- anti-epileptics
Name the BVs in the cranium that carry pain fibers.
- dural veins or sinuses
- meningeal arteries
- extracranial and proximal intracranial arteries
- extracranial veins
Name 6 general types of migraine abortive meds.
- aspirin
- acetaminophen
- NSAIDs
- ^^ med combos (+ caffeine, etc)
- SSRAs - selective
- SSRAs - nonselective
What are 3 abortive txs for tension headache?
- aspirin
- acetaminophen
- NSAIDs
What is the premonitory phase of a migraine?
alterations in mood, alertness, and/or appetite up to 24 hours before the HA
Who is 4x more likely to get cluster headaches?
men
What are 4 prophylactic treatments for tension headache?
- tricyclic antidepressants
- SSRIs (Prozac)
- psychotherapy
- PT
What are the most common and health-threatening conditions that underly secondary headaches?
- meningitis
- hemorrhage
- intracranial HTN
- giant cell arteritis
- traumatic head injury
At what age does giant cell arteritis present?
80s-90s
Who is 9x more likely to get ICP?
women
These are neuro symptoms preceding a HA (99% visual)
- must be visual, sensory, language, motor, brainstem, or retinal changes AND at least 2 of:
- unilateral symptoms
- gradual devel over 5+ mins lasts 5-60 mins
- accompanied or followed by migraine
- ***30% of pts experience these
the aura phase of a migraine
Name some migraine triggers.
- missed meals
- lack of adequate sleep
- EtOH
- caffeine withdrawal
- PMS
- “relief of stress”
- certain foods (MSG, nitrtes, tyramine)
What tests and results diagnose giant cell arteritis?
- elevated ESR
- elevated CRP
- positive temporal artery biopsy
What is the name of the lesser intensity HA due to a small hemorrhage that heralds a subsequent massive hemorrhage?
a sentinel HA
What are the s/s of giant cell arteritis?
- jaw claudication
- temporal artery region scalp tenderness
- blindness
- joint pain
- constitutional symptoms
This is the post-event exhaustion and lethargy in a migraine.
the resolution phase
Before or simultaneously with the onset of _____ symptoms, regional cerebral blood flow is decreased in the cortex corresponding to the clinically affected area or wider.
aura
Before or simultaneously with the onset of aura symptoms, ______ is decreased in the cortex corresponding to the clinically affected area or wider.
regional cerebral blood flow
This is caused by sensory stim of a particular area w/in the trigeminal sensory innervation.
trigeminal neuralgia
What is the aura phase of a migraine?
- neuro symptoms preceding a HA (99% visual)
- must be visual, sensory, language, motor, brainstem, or retinal changes AND at least 2 of:
- unilateral symptoms
- gradual devel over 5+ mins
- lasts 5-60 mins
- accompanied or followed by migraine
- ***30% of pts experience these***
What is a secondary headache?
- associated with underlying conditions or systemic pathology
- constant
- 10% of all headaches
DX?
- at least 10 episodes of HA that last 30 mins to 7 days
- at least 2 of the following:
- pressing or tightening sensation
- mild to moderate severity
- bilateral
- not aggravated by phys activity
- NO nausea/vomiting
- EITHER photophobia OR phonophobia
tension headache
Name 3 basic structures that carry pain fibers in the cranium.
- the meninges
- certain BVs
- the dermis
What is a primary headache?
- no known cause
- 90% of all headaches
- chronic or episodic
- can be tension, migraine, or trigeminal autonomic cephalagias
Dx?
- jaw claudication
- temporal artery region scalp tenderness
- blindness
- joint pain
- constitutional symptoms
giant cell arteritis
What is the resolution phase of a migraine?
the post-event exhaustion and lethargy
Name 3 causes of subarachnoid hemorrhage (SAH).
- trauma
- ruptured aneurism
- AV malformation
Name 5 alternative/non-pharm treatments for migraines.
- supplements (Mg, B2, Butterbur)
- sleep
- acupuncture
- botox
- biofeedback
Name 6 abortive txs for cluster headaches.
- O2
- triptans
- ergotamine derivatives
- lidocaine
- corticosteroids
- nerve blocks
What are the 4 phases of a migraine attack?
- premonitory
- aura
- HA and assoc symptoms
- resolution
What are the 3 prophylactic txs for cluster headaches?
- calcium channel blockers
- lithium
- anti-epileptics
Dx?
very brief pain in the trigeminal nerve dist. lasting less than 1 sec up to 2 mins
- pain is one of the following:
- intense
- sharp
- superficial
- stabbing
trigeminal neuralgia
What is diagnostic for trigeminal neuralgia?
- very brief pain in the trigeminal nerve dist. lasting less than 1 sec up to 2 mins
- pain is one of the following:
- intense
- sharp
- superficial
- stabbing
What is the diagnostic criteria of cluster headache?
- at least 5 episodes of severe, unilateral, periorbital and/or temporal pain that lasts 15-180 mins
- recurs at least e/o day up to 8x/day
- one of the following ipsillaterally:
- conjunctival injection
- lacrimation
- nasal congestion
- rhinorrhea
- eyelid edema
- ptosis
- miosis
- facial swelling
- ear fullness
- restlessness/agitation
What is the diagnostic criteria for migraine?
- at least 5 recurring HAs that last 4-72 hours characterized by at least 2:
- unilateral
- pulsating
- moderate to severe intensity
- pain increases w/ phys activity
- AND at least 1 of these:
- nausea/vomiting
- photophobia/phonophobia
- AND at least 1 of these:
What often precedes subarachnoid hemorrhage (SAH)?
a sentinel HA (a lesser intensity HA due to a small hemorrhage that heralds a subsequent massive hemorrhage)
What are the diagnostic criteria of tension headache?
- at least 10 episodes of HA that last 30 mins to 7 days
- at least 2 of the following:
- pressing or tightening sensation
- mild to moderate severity
- bilateral
- not aggravated by phys activity
- NO nausea/vomiting
- EITHER photophobia OR phonophobia
Before or simultaneously with the onset of aura symptoms, regional cerebral blood flow is _____ in the cortex corresponding to the clinically affected area or wider.
decreased
What triggers trigeminal neuralgia?
sensory stim of a particular area w/in the trigeminal sensory innervation
What are the 3 txs for trigeminal neuralgia?
- anti-epileptics (gabapentin, pregablin, carbamazepine, topiramate)
- baclofen
- surgical decompression of the nerve
This is an alteration in mood, alertness, and/or appetite up to 24 hours before the HA.
the premonitory phase of a migraine
What is the pathophys behind trigeminal neuralgia?
- vascular compression of the trigeminal nerve
- demyelination of the trigeminal nerve w/in the pons
What innervates the structures in the cranium that carry pain fibers?
- the trigeminal nerve
- roots C2-C4
Dx?
- at least 5 recurring HAs that last 4-72 hours characterized by at least 2:
- unilateral
- pulsating
- moderate to severe intensity
- pain increases w/ phys activity
- AND at least 1/2 of these:
- nausea/vomiting
- photophobia/phonophobia
- AND at least 1/2 of these:
migraines
What is a sentinel HA?
a lesser intensity HA due to a small hemorrhage that heralds a subsequent massive hemorrhage
What is the most common cause of a sudden, intense, incapacitating, “thunderclap, worst headache of my life” headache?
subarachnoid hemorrhage (SAH)
Where does HA from uncontrolled HTN usually occur?
at the vertex
