Headache Flashcards
Primary vs. Secondary HA
primary = benign HA disorders
migraine, tension, cluster, post traumatic, drug rebound, other
secondary = headaches that are a sign of organic dz
these are ugly
steps to follow when someone comes in with the “worst HA of their life”
think: SAH until proven otherwise. 1st thing= get a CT. if it comes back negative, get an LP: CT can miss 5-10% of SAH.
Worriesome signs of HA
"worst HA" onset of HA after 50yrs atypical HA for pt HA with fever abrupt onset subacute HA progressive worsening over time drowsiness, confusion, memory impairment weakness, ataxia, loss of coordination parasthesias/sensory loss/ paralysis abnormal neurological exam
Common vs Classic migraine
common= no aura classic = aura: usually lasts 15-30 min, sometimes longer. commonly visual symptoms, but can be anything
Common migraine
moderate to sever intensity age of onset usually 20s, peaks 35-40 years (gets beter) more common in females UNILATERAL or Bilateral throbbing/sharp/pressure retreat to dark, quiet room
what likely causes migraine
neurogenic inflammation
Most common associated sx with migraine
Nausea, vomiting, photophobia, phonophobia
Chronic migraine
hx episodic migrane. HA 15 or more days/mo. headache lasting 4 hours or longer; for a period of at least 3 mo, not attributed to another disorder
Tension HA
mild to moderate. does not prohibit daily activities. more common in females bifrontal, biocciptal, band like b/l dull, aching, squeezing pressure no prodrome or aura
Cluster HA
severe, excrutiating.
more common in males
associated with sleep apnea
periorbital (orbitotemoporal) 100% U/L
nonthrobbing, sharp boring, penetrating pain
prodrome: burning of nose or inner canthus (i/l)
behavior: frenetic, pacing, rocking
sx associated with lcuster HA
i/l ptosis, miosis, conjunctival injection, lacrimation, stuffed or runny nose
HA triggers
hormones diet changes (weather, seasons, travel, altitutde) stress sensory stimul
acute treatment of migrain
triptans (5HT 1 agonists)
contraindications of triptan use
ischemic heart disease, CV, or cerebrovascular or peripheral vascular disease, uncontrolled HTN, severe renal or hepatic impairment, use within 24 hr of ergotamines, MAOI’s or other 5HT1 agonists.
Contraindications of DHE use
same as for tryptans
