Headache Flashcards
Difference btwn primary vs secondary headache syndrome
Primary = > 90% of HA
No underlying pathology
usu recurrent
Secondary = less than 10% of cases
underlying intracranial or systemic pathology
Tension HA
Frequency
Characteristics
10 episodes lasting 30min-7days
2 of the following:
1) pressing/tightening sensation
2) mild-mod severity
3) b/l
4) physical activity fine
No n/v, but +/- photo OR phonophobia
Tension HA
Treatment to stop
Treatment to prevent
Aspirin, acetaminophen, NSAIDS
TCA (amitryptiline), SSRI, psychotherapy, physical therapy
Migraine HA
Potential causes?
migraine with aura resembles?
perivascular release of vasoactive substances causing sensitization of trigeminal affernets, vasodilation, migraine pain
resembles cortical neuronal spreading depression (CSD) –> CBF decreases to affected area and spreads out
Migraine HA
Triggers
1) lack of sleep
2) ETOH
3) caffeine withdrawal
4) perimenstruation
5) “relief of stress”
6) foods
Migraine HA
more in males or female
more females
Migraine HA
Diagnostic criteria
at least 5 episodes that last 4-72 hrs
2 of the following:
1) unilateral
2) pulsation
3) mod - severe
4) incr with physical activity
1 of the following:
1) n/v/
2) photophobia
3) phonophobia
Migraine HA
Phases
1) premonitory= change mood, alert, appetite 24 hrs before
2) aura = neuro sx before HA
3) HA + symptoms
4) resolution = post HA exhaustion and lethargy
Migraine HA
Describe aura
reversible symptoms of one of
visual, language, sensory, motor, brainstem, retinal
2 of
homonymous visual or unilateral sensory change, gradual over 5min, sx btwn 5-60 min then HA
Migraine HA
Treatment to stop
ASA, acetaminophen, NSAID
combo = ibuprofen + caffeine + ASA
or Acetaminophen + caffeine + ASA
5HT agonists
selective = triptans (5HT 1B/1D agonists for vasoconstrict)
nonselective = ergotamine
Migraine HA
Treatment to prevent
1) beta blocker
2) CCB
3) TCA
4) antiepileptics
5) botox for chronic migraine
Migraine HA
Alternative therapy
1) sleep
2) biofeedback
3) acupuncture
4) OTC/herbal, vit B2, Mg2+
Cluster HA = trigeminal autonomic cephalgias
1) frequency
2) men or woemn
3) triggers
1) rare
2) more in men
3) triggers = EtOh and vasodilators
Cluster HA = trigeminal autonomic cephalgias
diagnosis
5 episodes of severe, unilateral, periorbital and/or temporal pain for 15-180 min
recur every other day 8x/day
one of the following autonomic sx
Cluster HA = trigeminal autonomic cephalgias
treatment to stop
1) oxygen
2) 5HT agonists (triptan, ergots)
3) lidocaine
4) corticosteroids
5) nerve blocks
Cluster HA = trigeminal autonomic cephalgias
treatment to prevent
1) CCB
2) lithium
3) antiepileptics
Secondary HA
head trauma = concussion
demographics to get post-mild TBI HA
symptoms
treatment
young pts and men less likely to get post-mild TBI HA
pain within 1 week resolve by 3 months
dizziness, poor concentration, irritable, insomnia
treatment = pain meds
Secondary HA
infection = meningitis = bacteiral, fungal viral
symptoms
diagnosis
acute pain less than 2 days
HA, n, v, fever, stiff neck, altered consciousness
Kernig’s
brudzinski’s
dx = lumbar puncture
Secondary HA
vascular disorders = SAH
usu from?
sx
usu from trauma or ruptured aneurysm, AVM
sudden worst HA of life, stiff neck, photophobia, n/v, obtunded
Secondary HA
SAH diagnosis
treatment
diagnosis = immediate CT, LP = xanthochromia ~ 12 hrs), CTA
treatment = depends on cause = surgery
Secondary HA
vascular disorders = Giant cell arteritis
due to?
risk factor
inflamm of elastic lamina
risk factor = age
Secondary HA
giant cell arteritis
symptoms
jaw claudication
temporal artery tenderness
vision loss (optic nerve infarct)
joint pain
fever, malaise, weight loss
Secondary HA
giant cell arteritis
diagnosis
treatment
dx = high ESR, CRP, temporal artery biopsy
tx = steroids
Secondary HA
Incr ICP
ddx
1) tumor
2) AVM
3) infection
4) SAH, intracerebral hemorrhage, dural venous thrombosis
5) minocycline
6) trauma
7) pseudotumor cerebri or idiopathic intracranial HTN
Secondary HA
incr ICP
symptoms?
1) exertional HA
2) retrobulbar pain
3) n/v
4) pulsatile intracranila noises
5) transient visual obscure
6) diplopia
1) papilledema
2) vision loss
3) HA worse when wake up
Secondary HA
incr ICP
dx
treatment
dx = measure ICP, CT/MRI / NO LUMBAR PUNCTURE
treatment = depends
pseudotumor cerebri
appearance on LP and imaging
neuro exam
seen more in…
LP and imaging = normal
normal neuro except papilledema and CN 6 palsy
obese, middle age, women
how to diagnose HA?
1) detailed history
2) exclude secondary HA
SSNOOP
pneumonic SSNOOP
systemic symptoms (fever, weight loss)
secondary risk factors (HIV, cancer, auto)
Neuro (confusion, depress conscious, focal)
Onset (sudden, abrupt, first or worst)
Older (new or progressive esp older than 50)
previous HA (frist, changed freq or clinical features)
cranial neuralgia = trigeminal neuralgia
1) primary or secondary
2) causes
1) both primary + secondary
2) causes = idiopathic (primary), vascular compression of vessel on trigeminal nerve (secondary), demyelination MS (secondary)
cranial neuralgia = trigeminal neuralgia
diagnosis
triggers
1) very brief (up to 2 min) in trigeminal
2) intense, sharp, superficial, or stabbing
3) triggered by stim of trigem (chew or brush teeth)
cranial neuralgia = trigeminal neuralgia
treatment
antiepileptics
baclofen
surgical decompression
Episodic headache for 12 years
Duration of episodes: 5-12 days
Frequency of episodes: 1-2/month, worsening
Features: neck stiffness and pain, radiating whole head (“exploding”)
P/P, severe N and V → dehydration, weight loss
swollen eyelids, balance difficulties
Head CT: normal. Nerve stimulator C1-C2
No reponse to numerous therapies
Diagnosis: Chronic Migraine
Significant improvement with Botox injections
