Headache Flashcards
How does an intracranial lesion cause headache pain?
Tumors and hemorrhages do not produce pain by itself- the swelling around it may cause headache by stretching or compressing blood vessels or cranial nerves
Differentiate a primary from secondary headache
PRimary: Headache is primary manifestation
Secondary: headaches is secondary manifestation of an underlying disease process
What are the 4 most common headaches?
1) tension-type
2) Migraine and variants
3) Provoked by fever or hunger
4) Nasal, paranasal, ear, tooth, eye disease
“Worse headache of her life” usually indicates what etiology of head pain?
vascular
If someone presents with a headache that occurred in a split second, worst/horrible pain, and includes vertigo, vomiting or LOC, what must you immediately check for?
Aneurysmal subarachnoid hemorrhage or cerebellar hematoma
If someone presents with a headache accompanied by a fever and a rash, what are you concerned of?
Meningitis
If someone presents with a headache in an immunocompromised state, what are you concerned for?
Cryptomeningitis or toxoplamosis
If someone presents with a headache and either a coagulopathy or anticoagulation, what are you concerned about?
Subdural or intradural hematoma
What is a migraine?
Primary headache disorder- genetic condition in which a person has a predisposition to episodic headaches, GI dysfunction or neurologic dysfunction
What are three clinical questions to ask your patients to determine whether or not their headaches are migraines?
Headaches are combined with:
1) Nausea
2) photophobia
3) discomfort that limits daily activities
Severity is not a factor
What are the symptoms of a migraine?
POUND P-Pulsatile (usually unilateral) O- One-day duration U- Unilateral N- Nausea D- Disabling
What is the first phase of a migraine headache?
- Prodrome: 6 days –> 48 hours before a migraine occurs. Includes feelings of depression, irritability, drowsiness, fatigue, yawning, rhinorrhea/lacrimation, and hunger/thirst
WHat is the second phase of a migraine headache?
Aura - most commonly visual, but could also be sensory/motor.
Most commonly occurs before a headache, but can also occur during or after
Due to spreading cortical depression
How does an aura affect reading?
Auras are characterized by a blind spot near the center of vision
What is the third phase of a migraine?
Pain- may be in the head, abdomen or chest
Describe the onset of pain in a migraine
THe onset of pain is GRADUAL over minutes to hours, and can last hours to days.
Can be associated with photophobia, phonophobia, nausea/vomiting, and osmophobia/thermophobia
- patients want to lie down in a cool, dark, quiet room.
What is the role of the NMDA receptor in migraine headaches?
Spreading cortical depression
A genetically susceptible patient has a multifocal defect in brain metabolism leading to a gain of function of the NMDA receptor function
Excitation of the NMDA receptor leads to a burst of focal cerebral activity –> positive symptoms
Burst is followed by a loss of neuronal activity –> Cortical depression
In which lobe does spreading cortical depression usually originate?
Occipital