Headache Flashcards
most common type of headache
tension type headache
2nd: headache from systemic infection
physiology of pain
peripheral nociceptors are stimulated in response to tissue injury, visceral distention, or other factors
pain producing pathways in CNS/PNS are damaged or activated inappropriately
areas of referred pain
MMA = retroorbital
proximal mca/aca = temporal
supratentorial structures = ant 2/3 of head
infratentorial structures = vertex, back of head and neck
most common primary headache syndromes
migraine
tension type headache
cluster headache
ichd diagnostic criteria for migraine without aura
at least 5 attacks with criteria:
headaches 4-72 hrs, untreated or unsuccessfully treated
>/= 2 of the following: unilateral, pulsating, moderate-severe, aggravation or causing avoidance of routine physical activity
>/=1 of the following DURING:
nausea or vomiting
photophobia and phonophobia
no better diagnosis
ichd diagnostic criteria for migraine with aura
at least 2 attacks fulfilling b and c
>/= 1 of the ff reversible symptoms: visual, sensory, speech and/or language, motor, brainstem, retinal
at least 2:
***
diagnostic criteria for chronic migraine
> 15 days/month for > 3 mos
fulfill migraine with our without aura criteria
**
indications for preventive treatment in migraine
as prophylaxis
4x/month
moderate to severe
excessive use of symptomatic treatment without relief
most common medications for preventive treatment of migraine
tca (amitriptyline) b blockers anticonvulsants (topiramate) flunarizine botulinum toxin cgrp monoclinal antibodies (erenumab)
characteristics of abortive treatments for migraine
better is used at onset
must not be abused, can cause rebound headache
do not give more than 3 days/week
most common acute/abortive treatment for migraine
sumatriptan
ergots (DHE nasal spray, DHE injection)
cgrp receptor antagonists
diagnostic criteria for cluster headache
5 attacks
severe or very severe unilateral orbital, supraorbital, or temproal pain, 15-180 mins if untreated
either or both:
1 at least 1: conjunctival injection and/or lacrimation, nasal congestion and/or rhinorrhea, eyelid edema, forehead and facial sweating/flushing, fullness in ear, miosis and/or ptosis
2 restlessness/agitation
frequency between one every other day and 8/day fore than 1/2 time disorder is active
abortive treatments for cluster headache
100% oxygen via face mask for 10-15 mins
verapamil 80 mg qid + ecg
preventive treatments for cluster headache
single dose ergotamine or serotonin agonist
verapamil 480 mg/day
lithium
prednisone 75 mg daily x3 d
types of tension type headache
episodic types: peripheral pain mechanisms
chronic type: central pain
most significant abnormal finding in tension type headache
increased pericranial tenderness (interictally, exacetbated during acutal headache, increases with the intensity and frequency of headaches)
diagnostic criteria for tth
10 episodes
30 min-7 days
>/= 2: bilateral, pressing/tightening, mild-moderate, not aggravated by routine physical activity
both: no nausea or vomiting, no more than one photophobia or phonophobia
types of episodic tth
infrequent: <1 d/month or <12 d/year
frequent >/= 1 but <15 d/month for >/= 3 mos
>/= 12 and < 180 days/year
diagnostic criteria for chronic tth
same except for
headache occurring on >/= 15 d/month on ave for >3 mos
causes of tth
hunger, lack of sleep, stress, overexertion, depression and anxiety, dehydration
treatment for tth
paracetamol or nsaids
anxiolytics and antidepressants
non-pharmacologic
red flag signs for headache
systemic symptoms and disease neurological symptoms onset (thunderclap, sudden) older (>50 yo) secondary illnesses
indications for lp
first and worst ha of patient’s life (subarachnoid hemorrhage)
severe, rapid-onset, recurrent HA (subarachnoid hemorrhage)
progressive ha
unresponsive, chronic intractable ha
characteristics of subarachnoid hemorrhage
table 7
characteristics of arterial dissection
table 8
characteristics of bacterial meningitis
table 9
characteristics of brain tumor
table 10, seizure common presentation
characteristics of post-traumatic headache
milder, within 7 days of injury
similar to migraine or tension type headache
characteristics of giant cell arteritis
table 11
elevated crp
giant cell arteritis can lead to ___
stroke or blindness
tx for giant cell arteritis
corticosteroids
tx for cn neuropathies
gabapentin
pregabalin
carbamazepine
characteristics of trigeminal neuralgia
brief (secs to mins)
severe, sharp, stabbing
unilateral (bilateral = MS)
asymptomatic between attacks, normal facial sensation on PE
spontaneous or evoked pain with cutaneous trigger zones
characteristics of glossopharyngeal neuralgia
brief (secs to mins)
sharp, jabbing pain in throat, tongue, ear, tonsils
caused by small bv pressing on nerve on brainstem or cn 9
tx for glossopharyngeal neuralgia
respond to anticonvulsant drugs (carbamazepine and gabapentin)
surgery when unresponsive to therapy
location of herpes zoster opthalmaticus
ophthalmic division of trigeminal nerve
presentation of hz ophthalmaticus
periorbital vesicular rash distributed to affected dermatome
conjunctivitis, keratitis, uveitis, and ocular cranial nerve palsies
hutchinson’s sign (vesicles)
characteristics of hz oticus (ramsay hunt syndrome)
acute peripheral facial neuropathy associated with erythematous vesicular rash at ear canal, auricle, and/or mucous membrane of oropharynx
can also occur without skin rash (zoster sine herpete)
characteristics of tolosa hunt syndrome
severe unilateral, periorbital headache with painful ophthalmoplegia +/- pupillary abnormalities
inflammation in cavernous sinus or superior orbital fissure
