Headache Flashcards
What gender is at greater risk of migraines?
Females
What gender is at greater risk of cluster headaches?
Males
A 24 year old female presents for the sudden onset of the “worst headache of her life.” Her neurologic examination is notable for an enlarged and poorly reactive right pupil. What is the most likely diagnosis?
– A. Migraine Headache
– B. Aneurysmal subarachnoid hemorrhage
– C. Cluster headache
– D. Secondary pain related to acute angle closure glaucoma
– E. Tension headache
– B. Aneurysmal subarachnoid hemorrhage
A 28 year old male presents for complaint of visual problems and headaches. He reports the development of a shimmering light in his left visual field that gets bigger over the course of about 30 minutes, followed by a pounding left sided headache lasting several hours, associated with an upset stomach, light and sound sensitivity. What is the treatment of choice?
– A. Lorazepam 1.0 mg
– B. Inhaled oxygen 10 mL/min
– C. Sumatriptan 100 mg
– D. Methylprednisolone 1g
– E. Butalbital-acetaminophen combination therapy
– C. Sumatriptan 100 mg
What are some clinical features of migraines?
- nausea
- aura
- photophobia and phonophobia
What is the area of effect of migraines?
Usually unilateral
What is prodrome of a migraine?
A set of symptoms that occurs hours to days before onset of headaches
What is aura in migraines?
Most commonly visual lights that develop minutes before migraines occur
What is the cause of migraines?
Associated with release of neuropeptides including CGRP, Substance P, and Neurokinin A
– May lead to “neurogenic inflammation”
– Evoke vasodilation of pain-producing structures
– Creates a feedback loop with the trigeminal
pathway
What is the treatment for migraines?
Treat early with EFFECTIVE doses of NSAIDs
What are patients treated with if NSAIDs are not effective for their migraines?
Triptans
What is the function of triptans?
5HT1B/D agonists that lead to vasoconstriction
Triptan Contraindication
Avoid in those with vascular risk factors
What is the action of DHE and ergotamine for migraine treatment?
Arterial and venous vasoconstrictor with DHE having less prominent SE
DHE and Ergotamine Contraindications
Ischemic cardiac, cerebrovascular, or peripheral vascular disease and pregnancy
A 48 year old male presents for a severe boring pain in the left eye. What duration of symptoms is most consistent with cluster headaches? – A. 0-60 seconds – B. 60 seconds – 180 seconds – C. 180 seconds – 10 minutes – D. 10 minutes – 15 minutes – E. >30 minutes
– E. >30 minutes
What are some of the features of cluster headaches?
– Severe pain retro-orbitally
– 1-4 attacks/day lasting 20m to 3hrs
– Rapid onset over usually 15-30 minutes (not seconds)
– Invariably unilateral
What are cluster headaches associated with?
- Males
- Smokers
- Heavy Alcohol Use
What are some of the treatments for cluster headaches?
– Inhaled oxygen 100% by rebreather at 10-15 L/min
– Injectable sumatriptan
– Nasal spray triptans
What is the most common form of headache?
Tension Headache
What are the features of tension headache?
- Bilateral is not worsened by activity
- Phonophobia or photophobia but NOT both
- No nausea
What is the treatment of tension headache?
Treated largely with sleep
Trigeminal Neuralgia
Paroxysmalattacksofpain lasting from a fraction of a second to two minutes, affecting one or more divisions of CN V
What is the treatment for trigeminal neuralgia?
Carbamazepine is established as effective for controlling pain
Pseudotumor Cerebri
Headache with papilledema and no mass or lesion with normal CSF - EMERGENCY
What is the typical patient of pseudo tumor cerebri?
Typically an overweight female - increased
intracranial pressure from increased abdominal
pressure leads to papilledema in eye
Primary Exertional Headache
Pulsating HA lasting from 5 min to 48 hours, and occurring only during or after physical activity
