Headache Disorders Flashcards
What are the primary headaches
Migraines, Tension, Cluster
What are the secondary headaches
Substance, trauma, illness/infection, tumor
What are symptoms that suggest the headache is secondary (Hint: SNOOP)
S: Systemic symptoms or illness N: Neurologic symptoms (impaired consciousness, impaired cognition, impaired motor function) O: Onset (Sudden and abrupt) O: Older patients (age greater than 50 yrs old) P: Previous headache history (Develop after primary headache)
T/F: Primary headaches usually occur in patients age 18 to 40
True
What are diagnostic tests to check for a type of headache
CT scan, MRI, Labs
What are the two subclasses of migraines (prevelance)
With aura (30%), without aura (70%)
What is the pathophysiology of migraines
1) Slow wave of depolarization follwed by suppresion of brain activity
- Spreads to cause pain and possibly aura
2) Activation of trigeminovascular system
- Substance P, CGRP, and NKA causing inflammation in pain-sensitive meninges
3) Neuronal Sensitization
- Low tolerance for light or sound with more pain due to lower threshold
What are the criteria that must be present to diagnose a migraine WITHOUT aura
- Headache must last 4-72 hours
- Headache must have either 2 out of the 4 characteristics
- Unilateral location
- Pulsating quality
- Moderate or severe pain intensity
- Aggravation by or causing avoidance of routine physical activity
- During the headache 1 of the 2 events must occur
- Nausea/vomitting
- Photophobia and phonophobia
- Not attributed to any other disorder
- MUST BE 5 HEADACHES FULLFILLING THIS CRITERIA
What are are episodic migraines, chronic
Episodic: less than 15 monthly migrained days (MMDs)
Chronic: 15 or more monthly headaches days (MHDs) with at least 8 as MMDs
What are the criteria that must be present to dianose a migraine WITH aura
- One or more fully reversible aura symptoms
- Visual
- Sensory
- Speech and/or language
- Motor
- Brainstem
- Retinal
- At least 3 characteristics of the aura
- At least aura symptom spreads gradually over 5 minutes
- two or more aura symptoms occur insuccession
- Each inidvidual aura symptoms last 5-60 minutes
- At least one aura symptom is unilateral
- At least one aura symptoms is positive
- The aura is accompanied, or followed within 60 minutes, by headache
What are positive types of aura, negative, examples of aura
flashing or flickering lights, visual distortions/ partial loss of vision or blind spot with half vision lost
Visual distubances, temporary loss of sigh, numbness and tingling on part of the body
T/F: Patients usually have GI distress along with migraines
True
What are tools used to screen migraines, when is medication recommended in each score
MIDAS: Level 2/Mild disability (greater than 6)
HIT-6: Some impact (score greater than 50)
What is the difference between migraines and tension type headaches
Tension headaches are bilaterally and feels like a pressure with a headband formation with a mild to moderate pain not aggravated by routine physical activity (NO AURA)
If a patient has chronic tension-type heaches what is more likely to be the problem
Medication-induced, associated with a comorbidity
What are symptoms of cluster headaches, what is the key correlation of cluster heaches
Unilateral but most of the pain is in the face and banding around the bottom of the head, history of tobacco use
What classifications must be met to be classified as a cluster headche
- Severe or very severe unilateral orbital, supraorbital and/or temporal pain last 15 to 180 minutes if untreated
- Heache is accompanied by one or more ipsilateral conditions
- Eye involment
- Nasal conjection
- Eyelid edmea
- Forehead and facial sweating
- Agitation
- Attacks have a frequency from one every other day to 8 per day
- MUST HAVE AT LEAST 5 ATTACKS
What is the key characteristics that classify this headache as cluster
Occur daily for a week to several months followed by pain free intervals (Remission)
How are medication overuse headaches diagnosed
Patients having a headache occuring on greater than 15 days per months WITH A PRE-EXISTING PRIMARY HEADACHE DISORDER, regualar overuse for GREATER than 3 MONTHS of one or more drugs taken for acute or symptomatic treatment of headache
What medications can cause Medication overuse headaches, what subgrous do they belong to
Simple analgesics: NSAIDs, acetaminophen, asprin (Use over 15 days per month for over 3 months)
Combination analgesics: ergots, triptans, and opiods (Use over 10 days per month on a regular basis for over 3 months)
T/F: One medications are ceased in Medication Overdose headaches the pain will stop
False: Patient may have withdrawl symptoms lasting 2 to 10 days including withdrawl headaches, nausea/vomiting, sleep distubances, restlessness, anxiety as well as other symptoms
What are non-pharmacologic managment of migraines
Identify indvidual triggers and avoid for greater than 4 weeks, smoking cessation, adequate sleep (in a dark quiet place), eat on a regualr schedule and limit caffeine, manage stress, behavioral interventions (biofeedback +/- relaxtion therapy and acupuncture)
What is the course of action if a patient has migraines with severe nausea or vomiting with mild to moderate symptoms
- Pretreat with an antimemtic
- Simple analgesic: acetaminophen, NSAIDs, ibuprofen, naproxen
with inadequate response
- Combination analgesics: Excedrin (Acetaminophen/Aspirin/Caffeine)
With inadequate response
- Triptans, Dihydroergotamine or ergotamine tartrate
What are premonitory symptoms in migraines
Irritability, Depression, yawning, increased need to urinate, food cravings, hard to concentrate, hard to sleep
T/F: All of the headache types are more common in women except cluster headaches
True
