Headache Flashcards
Migraine or headache pain are almost as common as back pain and the burden of headache is highest for females ages ___
18 to 44
In new onset and severe headache, the probability of finding a potentially serious cause is Considerably___ than in recurrent headache.
greater
*Patients with recent onset of pain require prompt evaluation and appropriate treatment
Serious causes of severe acute onset of HA to be considered include
- meningitis,
- subarachnoid hemorrhage,
- epidural hematoma or
- subdural hematoma,
5, glaucoma,
6, tumor, and - purulent sinusitis
Among secondary causes of headache, ___ is by far the most prevalent, Followed by ___, Both of which are readily ruled out by a Good review of systems and physical exam.
Systemic infection
head injury
*Vascular disorders and brain tumor, common concerns for patients, Are relatively Low In prevalence among the causes of secondary headache.
Among primary causes of headaches, ___ is by far the most prevalent
tension headache
*Almost 4 times as prevalent as migraine
Migraines still make up __% of primary headaches, __ times more common than the rare cluster headache
16
160
Most common types of primary HAs
- Tension
- Migraine
- Idiopathic stabbing
- Exertional
- Cluster
Most common types of Secondary HAs
- Systemic infection
- Head injury
- Vascular disorder
- Subarachnoid hemorrhage
- Brain tumor
Secondary HA red flag symptoms
- Systemic symptoms (fever, weight loss, vomiting preceding HA)
- Secondary risk factors: underlying disease (HIV, cancer)
- Neurologic symptoms (confusion, impaired alertness)
- Onset: sudden, abrupt or split-second (first severe HA, worst ever)
- Older: new onset and progressive HA over days/weeks, esp age > 55 or under age 5
- Previous HA history or HA progression: pattern change, first HA, or different (change in quality, frequency or severity)
- Pain induced by bending lifting or cough
- Wakens from sleep or presents immediately upon awakening
___ is an essential first step in the evaluation of headache.
A complete neurologic exam
In one study, __, __ and __ predicted serious intracranial pathology in adults presenting to an ED with nontraumatic HA. The presence of any one of these three features detected serious intracranial pathology with 98.6% sensitivity
age older than 50 years, sudden onset, and abnormal neurological exam
In most Cases, patients with __ or ___ should be evaluated by a CT or MRI study.
an abnormal neurologic examination or a history of recent new onset headache
- That concludes neuroImaging is usually not warranted for patients with migraine or a normal neurologic examination.
- An imaging study is not necessary in the vast majority of patients presenting with headache.
When is a LP indicated?
- clinical suspicion of subarachnoid hemorrhage in the setting of a negative or normal head CT scan
- Clinical suspicion of an infectious or inflammatory etiology of HA
An abnormal neurological exam may suggest:
Focal logic signs suggests an
- intracranial mass lesion,
- Arteriovenous malformation, Or
- collagen vascular disease.
Neck Stiffness and especially meningismus (Resistance to passive neck flexion) Is strongly suggestive of __
meningitis.
Papilledema suggests the presence of:
- an intracranial mass lesion,
- benign intracranial hypertension (Pseudotumor cerebri),
- Encephalitis, Or
- meningitis
Temporal artery palpation should be performed to rule out ___
temporal arteritis
Once we’ve ruled out serious underlying Pathology and secondary causes of headache, We may determine the type of primary headache using ___ as the primary diagnostic tool.
the patient history
Common primary causes of headache can be identified via
- location,
- characteristics,
- activity,
- duration, and
- associated symptoms
The term ___ is commonly used to describe a chronic head pain syndrome characterized by Bilateral tight, band like discomfort.
tension type headache
What is the main way to differentiate migraine from tension HA
tension type headache is that it is completely without accompanying features such as
- nausea,
- Vomiting,
- Photophobia,
- Phonophobia,
- Throbbing, or
- aggravation with movement
A core feature of cluster headache is ___
periodicity
*At least one of the daily attacks of pain recurs at about the same hour each day.
Describe the pattern of onset of cluster HAs
- The typical cluster headache patient has daily bouts of one or two attacks of relatively short duration and unilateral pain for 8 to 10 weeks a year;
- This is usually followed by pain free interval that averages a little less than a year.
* Patients are generally perfectly well between episodes - Onset is nocturnal in about 50% of patients
Describe whether men or women are more effected by migraines and cluster HA
Migraines: F>M
Cluster: M>F, 3x more
Cluster headache is associated with ipsilateral symptoms of:
- cranial parasympathetic autonomic activation:
- Conjunctival injection or
- Conjunctival lacrimation,
- Rhinorrhea or
- nasal congestion, Or
- cranial sympathetic dysfunction such as ptosis.
Compare the location of migraine, tension and cluster HAs
Migraine: 60-70% unilateral
Tension: bilateral
Cluster: unilateral, usually begins around eye or temple (retro orbital)
Describe the characteristics and associated sx of migraine HAs
- Gradual onset
- Pulsating
- Moderate-severe pain
- Worse w/ activity
- N/V
- photo/ phonophobia
- aura
Describe the characteristics and associated sx of tenison HAs
- tight band-like
- fluctuating pain/ waxes and wanes
- pressure or tightness
- No associated N/V, aura, photo/phonophobia