Headache Flashcards
What are the 3 types of primary headaches?
Migraine, Tension, Cluster
Primary HA is diagnosis of exclusion
If patient reports his/her headache to be typical for them and to have come on slowly, is it more likely to be a primary or secondary headache?
Primary
Get this hx by asking if pt has had HA like this before and if their HA is the worst they’ve ever had
What headache qualities are cause for concern?
Non typical HA for pt Worst HA of life Altered consciousness Focal neurologic symptoms Abrupt onset Progressively worsening daily HA Toxic appearing/ abnormal vitals
How do Migraine, Tension, Cluster and Brain Tumor HA time courses differ?
Migraine - regularly periodic
Tension - consistent with few days of relief
Cluster - bursts of episodes clustered together
Brain tumor - consistently worsening
How do tension HA and migraines differ in pattern of pain?
Tension - Bilateral forehead and down into neck
Migraine - unilateral, commonly occular and frontal region
What are the diagnostic criteria for tension HA?
At least 10 previous HA like this HA lasts for 30 mins - 7 days At least 2 of: - pressure, tightness - mild-moderate intensity - bilateral distribution - not aggravated by physical activity No nausea or vomiting \+/- Photophobia or Phonobia - NOT both, commonly neither
What are risk factors for tension HA?
More common in women Associated with lower SES TMJ Dysfuncion Stress Analgesic overuse Depression
How can you treat your tension HA while studying for Neuro?
NSAIDs/ Acetaminophen
Combination products (Excedrin) that include caffeine
Identification of triggers
Heat, warm bath, muscle relaxants
Physical therapy
Severe - Anti-emetics, Barbiturates, Opiates
Treat depression if it exists (some anti-depressants have mechanism to address tension HA simultaneously)
What are possible causes of chronic daily headache?
Secondary to overuse of medications (opioids, ASA, tylenol, NSAIDs, ergotamines, barbiturates, triptans)
Depression
PTSD
Hx of sexual abuse
Intracranial pathology (Mass, CSF leak)
COPD, Thyroid condition, HTN, Sleep Apnea
How can chronic daily headache be treated?
Treat underlying issue Slowly wean off offending meds Psychotherapy/ CBT Regular exercise Healthy eating
Who is most likely to have migraines?
Those with family history (90%)
Females 3:1 over males
Onset at adolescence or early adulthood
Lifetime prevalence 18%, Annual prevalence 13%
What are the differences between classic migraines and common migraines?
Classic (20%) - Aura
- Focal neuro deficits (speech change, vision loss/ field cuts, tingling, weakness, confusion)
Common (80%) - No Aura
- No focal neuro deficits but may feel: “fuzzy in head”, sad, fatigued
Both - Nausea and vomiting
Other Migraines (don’t think these will be tested but just in case…)
Basilar Artery - diplopia, tinnitus, vertigo, gait disturbance, bilateral paresthesias
Retinal - monocular vision loss
Opthalmoplegic - extra-ocular weakness, typically 3nd nerve and pupil involvement
“Migraine Equivalents” - aura without headache
Abdominal - abdominal pain
21 yo otherwise healthy female presents with unilateral right frontal headache with associated nausea, present for 1 hour. Pt took NSAID w/o relief. She states her mother has history of migraines. What treatment are you most likely to employ after ruling out secondary HA?
Triptan (Imitrex, Maxalt, Zomig) - 5HT1 agonist, vasoconstrictor (contraindicated in CAD or uncontrolled HTN)
Ergotamines
Anti-emetics (promethazine or metoclopramide)
IVF
Maybe Steriods
Opiates - careful of rebound HA
At what point should migraine prophylaxis be considered?
4-5 migraine days/mo with normal functioning
2-3 migraine days/mo with some impairment
2 migraine days/mo with severe impairment
