Headache Flashcards
What is the difference between a primary headache and a secondary headache?
Primary headaches are benign and are not related to an underlying disease process. Secondary headaches are a manifestation of an underlying disease process
What diagnoses are associated with headaches described as “split second, unexpected, worst/not previously encountered, LOC, vertigo, vomiting”?
Aneurysmal subarachnoid hemorrhage
Cerebellar hematoma
What diagnoses are associated with headaches accompanied by fever and skin rash?
Meningitis
What diagnoses are associated with headaches in immune-suppressed patients?
Crypto meningitis
Toxoplasmosis
What diagnoses are associated with headaches in addition to coagulopathy or anticoagulation therapy?
Subdural or intradural hematoma
What are the 3 key clinical questions used to diagnose migraine?
Nausea/sick to stomach?
Light sensitivity
Pain limiting daily activities
Severity is not necessarily a feature
Typical clinical presentation of a migraine
Periodic unilateral pulsating headache beginning in late childhood/early adulthood. More common in women than men. Associated with specific triggers.
What are some common triggers of migraines?
Stress, lack of sleep, hunger, hormonal fluctuations, certain foods/lack of food, alcohol/nitrates, weather changes, smoking, scents, fumes
What are the phases of a migraine headache?
Prodrome (6-48hr before)
Aura (visual disturbances)
Pain
Postdrome
Describe the visual aura of a migraine
A blind spot near the center of vision that prevents reading. Peripheral flashing/pulsating bands of light spread out across the visual field
What is spreading cortical depression (SCD)?
Susceptible patients may have a gain in NMDA-receptor function that leads to bursts of focal cerebral activity (causes positive symptoms). Following this burst, neuronal activity is suppressed.
Associated with a slow (3mm/min) spreading wave through the brain
What is the treatment for migraines?
Treat early with high doses of NSAIDs or triptans (if NSAIDs) do not work.
How do triptans work?
Agonists of 5HT1B/D receptors leading to vasoconstriction, which decreases the inflammatory process responsible for migraine headaches
What is the major contraindication for triptan prescription?
Avoid triptan use if patient has or has high risk of ischemic heart disease, pregnancy
What is serotonin syndrome?
Excessive activation of 5HT1a and 5HT2 receptors causes leg rigidity, dysautonomia and encephalopathy. Happens within 24 hours of medication exposure/change
How does BoTox help with migraine headaches?
Very strong muscle relaxant, used in cases where multiple other medications do not work
What is a cluster headache?
One of the most severe headache types, more common in men than women. Associated with smoking and drinking. Unilateral, rapid onset with 1-4attacks per day for 20m-3hr
What medications are used for cluster headache?
Inhaled oxygen
Supatriptan injections
Intranasal: triptans, lidocaide, DHE
Prednisone
What is the most common type of headache?
Tension headache (35-75% of adults)
What are the clinical features of a tension headache?
Bilateral pain for 30min-6hours with a pressure/tightening quality. Not associated with nausea/vomitting.
Often resolves with improved sleep, diet, exercise habits
What is the difference between trigeminal neuralgia and cluster headaches?
Trigeminal neuralgia is more rapid and electricity-like pain along the jaw line. Cluster headaches last longer and are typically felt behind the eye.
What is pseudotumor cerebri?
A medical emergency in which increased intracranial pressure causes headaches. Risk for blindness if not treated.
What is a primary exertional headache?
A pulsating headache that occurs during or after physical activity for 5min-48h. Typically in young males.
