Headache Flashcards
Migraine Diagnostic criteria
Pain: Throbbing Unilateral Mod-severe Worse with routine activity
Associated symptoms:
Photophobia and phonophobia
Nausea and vomiting
Other:
Duration 4-72 h
Recurrent headaches (at least 5)
No secondary cause
Pseudo tumor Cerebri
Hx: recent weight gain
Medications: retinoids, antibiotics, oral contraceptives, growth hormone
SX: decreased visual acuity, papilledema, diplopia (CN6)
Chronic daily headache
Tinnitus
IX: imaging, including dural sinuses
LP: measure opening pressure
Consequences: visual field defect and blindness
Tx: acetazolamide, weight loss, shunt
Tension Headache diagnostic criteria
At least 10 headaches
30 min-7days
Two of: bilateral, pressing/tightening, mild-severe, not aggravated by routine activity
Both of: no nausea/vomit, only 1 of photo/phonophobia
Diagnostic Criteria for Cluster Headache
At least 5 attacks, very severe, 15-180 min.
Unilateral, retro/supraorbital/temporal
One of: ipsilateral conjunctival injection, nasal congestion, eyelid edema, facial/forehead sweating, miosis, ptosis, restlessness
What are the pain sensitive structure in the head?
Scalp periosteum skull dura dural arteries, large veins Pial arteries Falx cerebri Venous sinuses Nasal Sinuses Large intracerebral arteries CN-V, VII, IX, X
Sensitization
Lowered response threshold of sensory receptors (peripheral nociceptors)
Allodynia
Non-noxious stimuli induces perception of pain
Ddx thunderclap headache
Subarachnoid hemorrhage Dural sinus thrombosis Pituitary apoplexy bleed into tumor arterial dissection reversible vasospasm spontaneous intracranial hypotension
Headache red flags
Systemic symptoms Thunderclap onset Older age Progressive tempo Signs/sx raised ICP
Aura
Transient focal neurological symptoms of gradual onset, which are completely resolved within 60 minutes. Visual most common.
Path: wave of spreading cortical depression
Chronic daily headache differential
Tension headache Medication overuse Chronic migraine Hemicrania continua New daily persistent headache
Chronic daily headache differential
Tension headache Medication overuse Chronic migraine Hemicrania continua New daily persistent headache
Migraine treatment
NSAIDS
Acetominophen
Triptans (never in CV disease)
Watch out for medication overuse headaches)
Triptans
Mech: serotonin agonists
Contra: CV disease, uncontrolled HTN, atypical migraines
Indication: abortive therapy of typical migraines
CGRP agonists
Mech: Antibodies to vasodilating peptide?
