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Phar 507 > Headache Disorders > Flashcards

Headache Disorders Flashcards

1
Q

What are the primary headaches

A

Migraines, Tension, Cluster

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2
Q

What are the secondary headaches

A

Substance, trauma, illness/infection, tumor

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3
Q

What are symptoms that suggest the headache is secondary (Hint: SNOOP)

A

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)

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4
Q

T/F: Primary headaches usually occur in patients age 18 to 40

A

True

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5
Q

What are diagnostic tests to check for a type of headache

A

CT scan, MRI, Labs

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6
Q

What are the two subclasses of migraines (prevelance)

A

With aura (30%), without aura (70%)

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7
Q

What is the pathophysiology of migraines

A

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

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8
Q

What are the criteria that must be present to diagnose a migraine WITHOUT aura

A
  • 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
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9
Q

What are are episodic migraines, chronic

A

Episodic: less than 15 monthly migrained days (MMDs)

Chronic: 15 or more monthly headaches days (MHDs) with at least 8 as MMDs

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10
Q

What are the criteria that must be present to dianose a migraine WITH aura

A
  • 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
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11
Q

What are positive types of aura, negative, examples of aura

A

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

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12
Q

T/F: Patients usually have GI distress along with migraines

A

True

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13
Q

What are tools used to screen migraines, when is medication recommended in each score

A

MIDAS: Level 2/Mild disability (greater than 6)

HIT-6: Some impact (score greater than 50)

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14
Q

What is the difference between migraines and tension type headaches

A

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)

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15
Q

If a patient has chronic tension-type heaches what is more likely to be the problem

A

Medication-induced, associated with a comorbidity

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16
Q

What are symptoms of cluster headaches, what is the key correlation of cluster heaches

A

Unilateral but most of the pain is in the face and banding around the bottom of the head, history of tobacco use

17
Q

What classifications must be met to be classified as a cluster headche

A
  • 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
18
Q

What is the key characteristics that classify this headache as cluster

A

Occur daily for a week to several months followed by pain free intervals (Remission)

19
Q

How are medication overuse headaches diagnosed

A

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

20
Q

What medications can cause Medication overuse headaches, what subgrous do they belong to

A

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)

21
Q

T/F: One medications are ceased in Medication Overdose headaches the pain will stop

A

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

22
Q

What are non-pharmacologic managment of migraines

A

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)

23
Q

What is the course of action if a patient has migraines with severe nausea or vomiting with mild to moderate symptoms

A
  • 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
24
Q

What are premonitory symptoms in migraines

A

Irritability, Depression, yawning, increased need to urinate, food cravings, hard to concentrate, hard to sleep

25
Q

T/F: All of the headache types are more common in women except cluster headaches

A

True

Phar 507 (33 decks)

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