Headache Flashcards
When should we worry about headache?
SNOOPS Systemic Symptoms Neuro signs Onset (sudden) Old (50+ w/ new headaches) Prior History Secondary Illness
What are the charicteristics of Traction Headaches?
Steady, non-throbbing, deep, dull ache; can awaken from sleep
Progressive freq and dur
Cause: Neoplasm, abcess, Chronic SDH
WHat are the traits of Subarachnoid Hemorrhage?
Peaks within one minute (very intense) (thunderclap)
Intracerebral bleeding, embolic stroke, trauma, RCVS
CSF needed even if CT neg
What are the complications of Reversible Cerebral Vasocontstriction Synd?
Local Cortical SAH
Stroke
Posterior Reversible Encephalopathy Synd
What are the traits of a Meningitis Headache?
Similar to migraine -severe and global -throbing -N/V, photophobia CSF culture needed
What causes a Low pressure headache?
Post LP
CSF Rhinorrhea
Inappropriate shunt
1^ IC Hypotension
What causes a High pressure headache? Features?
Idiopathic IC HTN
Risk of permanent visual loss
Papilledema
What are the features of Cranial Arteritis?
Tender artery ESR >60mm/hr Throbbing/boring/burning JAW CLAUDICATION Steroid Tx to prevent blindness
What are the features of Trigeminal Neuralgia?
Trigeminal distribution -No autonomic symptoms -Bilateral? MS -Brainstem Tumors -Idiopathic or microvascular-compressive Tx: AED(lamotrigine)
What is CADASIL?
Cerebral AD Arteriopathy w/ subcortical infarcts and leukencephalopathy
What are features of Episodic Tension type headache?
most common 1^ headache
Non-pulsitile
Non-disabling
Relief with OTC analgesics
What combo of symptoms qualify a Migraine?
2 of: Unilateral, throbbing, worse w/ movement, mod or severe
1 of: N/V, Photophobia, Phonophobia
What is the primary cause of migraine headache ?
Hyperexcitable: Visual Cortex
Dysmodulated: Dorsal Pons
What is reqired in order to have a sinus headache?
Sinusitis
Purulent nasal drainage
Pathologic sinus findings
What is the acute Tx of Migraine HEadache?
Non-Presc: NSAIDS, caffeine, etc
Presc: Triptans, Narc combos, Dihydroergotamine, Dopamine Agonists w/ combo of others
Steroids
WHat is the MOA of Triptans?
Vasodilation of neural BVs Serotonin Receptor Agonists
What drugs are used for migraine prevention?
Topiramate Divalproex Na Timolol Propanolol Chronic? Botox
What are the principles of Sucessful Migraine Prevention?
Allow adequate time
Consider comorbids
Ensure no contraindications
Appropriate expectations
What are the traits of Cluster headachess?
Piercing unilateral stabbing pain; 1-10 per day; most male
**Ipsilateral lacrimation and nasal congestion
Pt active during attack
What are useful abortives for Cluster Headaches?
Sumatriptan
10-15 L/min O2
What meds are used for Prevention of cluster headaches?
Verapamil Divalproex Na Topirimate Lithium Oral steroids as bridge therapy
What are the traits and Tx of Paroxysmal Hemicrania?
Up to 40 attacks per day
Excellent response to Indomethacin
What are the traits of Hemicrania Continua?
SIDE LOCKED
No pain free periods-pain can wax and wane
AL one Autonomic symptom ips to pain
Complete response to Indomethacin is diagnostic
What are other Indomethacin Responsive headaches?
Cough, Coital, Idiopathic stabbing, exercise
MUST exclude posterior fossa lesion (chiari malf)
