Headache and Facial Pain Flashcards
vInDIcATEs
Vascular Infectious / Inflammatory Neoplasm Developmental / Degenerative Idiopathic / Iatrogenic Congenital Allergic / Auto-immune Trauma / Toxins Environment / Endocrine pSychiatric
how do you diagnose a HA?
By EXLUSION…have to see them twice at least
most important question?
HAVE YOU EVER HAD THIS HA BEFORE?
Likely to be primary if:
slow onset and typical for the pt.
time couse for migraine, cluster, tension, brain tumor?
migraine random, tension freqent daily, cluster many days separated by symptoms free, tumor is progressive HA
unilateral throbbing often behind eye
migraine
describe a migraine
prodromal, slow onset with aura, unilateral throbbing pain often behind the eye, N/V, photo and phonopobia. Women > men
Prevention of migraine?
Reduce triggers and daily prophylactic meds (bb, naproxen, amitripyline all level A evidence)
whole head pain that is not throbbing
tension HA
describe a tension HA
slow onset, whole head, may attribute to stress or nerves
-Usually no N/V, photo or phonopobia
treatment of tension HA
NSAIDS, tylenol, excedrin. Stress management, stretching neck, sleep hygiene, good food and same MIGRAINE prophylaxis possible
quick onset with severe pain HA
Cluster HA while ruling out SAH
describe a cluster HA
quick onset, severe, periorbital, temporal, or supraorbital with unilateral lacrimation, rhinnorhea, conjuctival injection, miosis, ptosis. Men > Women
tx of cluster
12-15 L O2 with non-rebreather for 15 minutes then opiates. Can use triptans and Migraine prophylaxis too.
describe a SAH
worst HA of my life OR altered mental status.
N/V and possible nuchal rigidity
fever and nuchal rigidity
menigitis
negative scan for SAH but high suspicion?
LP…xantochromia (RBC breakdown product)
progressively worsening HA and worse in morning? What else might you see?
Brain Tumor. N/V. now focal neurologic deficit and new onset seizures
First drug to try for trigeminal neuralgia?
anti-convulsants. Carbamazepine then phenytonin. Possibly gabapentin.
obses woman of childbearing age gets HA worsening over time. Also visual disturbance.
Pseudotumor cerebri (IIP idiopathic intracranial hypertension)
PE for psudotumor?
papilledema, obesity, decreased visual acuity
diagnosis of pseudotumor?
Clincial suspicion: CT for tumor (quick scan) and then LP
tx of pseudotumor cerebri?
aggressive weight loss, Na restriction, acetazolamide
Other causes of HA
sinusitis, dehydration, hangover, rebound HA, hypoglycemia, TMJ, lupus, temporal arteritis, venous sinus thrombosis
