Headache Flashcards
What are the three main HA classifications?
Primary HA/secondary HA/ cranial neuralgias and facial pain
What is a secondary HA?
A HA with an underlying cause
What is a primary HA?
A HA with no underlying cause
What are the three types of primary HA?
Tension, migraine and cluster
Does giant cell arteritis usually cause a unilateral or b/l HA?
Unilateral
What is Cushing’s triad suggestive of?
Herniation
Subhyaloid hemorrhage is seen with what?
Subarachnoid hemorrhage
When should you order a sed rate/CRP?
For suspected giant cell arteritis
CTA is good to identify what?
Subarachnoid hemorrhage
CTV is good for identifying what?
Changes in the venous system
Should HIV+ pt w/new HA get emergent imaging?
Yes
In what two cases should a pt w/HA get emergent imaging?
New onset with neuro changes OR sudden onset severe HA
If you suspect a pt has a subarachnoid but has a normal CT, what is the next step?
Do an LP
When should you image prior to getting an LP?
If you suspect a space occupying lesion
What is an absolute contraindication for an LP?
Cellulitis near puncture site
What type of meds is recommended for treatment of acute primary HA in the ED?
Nonopioid
What is another name for cluster HA?
Trigeminal autonomic neuralgia
When do migraines usually develop?
Adolescence or early adulthood
What is first line tx for migraines?
NSAIDs
What is the best NSAID for migraines?
Ibuprofen
Haldol and compazine are abortive meds for what?
Migraines
Serotonin agonists may cause what?
Cardiac ischemia
Serotonin agonists may not be combined with what?
SSRIs or MAOIs
Botox can be used as a tx for what?
Frequent migraines
Are cluster HAs usually unilateral or b/l?
Unilateral
What is the tx for cluster HA?
100% O2 via mask for 15 mins
What is the tx for tension HA?
Nonopioid therapy
What will you see on fundoscopic exam with giant cell arterities?
Papilledema
Can fever occur with giant cell arteritis?
Yes
Is impaired vision an early or late sign in giant cell arteritis?
Early
What is the giant cell arteritis diagnostic criteria?
ACR classification
What type of anemia is common in giant cell arteritis?
Normocytic anemia
Are LFTs elevated in giant cell arteritis?
Yes
What is the tx for giant cell arteritis?
Emergent steroids
What dose of steroids should someone w/giant cell arteritis be started on?
60mg prednisone daily
Syncope w/HA is suspicious for what?
Subarachnoid hemorrhage
Sentinel HA can start how long before subarachnoid hemorrhage?
10-20 days
Ottawa SAH rule is used when?
When pt has normal neuro exam
Serial EKG and trop should be done if suspicious for what type of HA?
SAH
When can a normal CT be used to r/o a SAH?
When CT is done within 6 hours of HA onset and pt has normal neuro exam
Maintain BP at what for SAH?
130-140 systolic
What is the tx for SAH if 2/2 AV malformation?
Surgical clipping
What will be in CSF if pt has SAH?
Blood
WBC will be less than what in LP for SAH?
5
What three labs should be drawn to diagnose CVST?
CBC, ESR, D-dimer
What imaging modality is used to diagnose CVST?
MRV
How to treat CVST?
Anticoagulation
Xanthocromia in the CSF indicates what?
SAH