Headache Disorders: Diagnosis And Mngmt Flashcards
When is immediate referral indicated
Pt presents with significant and progressive pain
Specially accompanied with any neurologic signs/symptoms
Fts that raise concern
New onest headache/orofacial pain = middle aged/elderly
Worsening headache
Headache sudden onset
Headache interrupts sleep
Headache precipitated by exertion, change of position, cough, sneeze
Neurological symptoms to head trauma
Atypical age of onset
Fever
Weight loss
Questions for history of headaches
How many types
When and how they begin, frequency
How long
When do they happen / precipitates them
Where pain starts/ how resolved
Quality/severity pain, additional symptoms
Aggravates/ reduces pain
Family history
Medication for headaches
Typical headache
Diagnosis
History
Physical exam
Diagnostic test in
History
Physical exam
Diagnostic testing
Primary headaches 3 major categories
Migraine
Cluster headache + chronic paroxysmal hemicrania
Tension type headache
Migraine
Considered in differential diagnosis
Migraine with aura
Migraine without aura
Migraine without aura
Idiopathic, recurring = 4 to 72 hours
Unilateral
Pulsating
Mod/severe intensity
Aggravation by routine physical activity
Nausea, photophobia, photophobia
Migraine with aura
Idiopathic
Recurring, begins with manifesting attacks of neurologic symptoms = 5 to 20 min, last longer than 60 min
Headache, nausea, photophobia follow
4-72 hours
Migraine facts
Women more men
30% women, 17 % men 3rd decade
Family history - genetic factor
Tx= pharmacological and non
Pharmacological medication migraine
Abort the migraine and those that prevent the migraine
Abortive
Analgesics
Narcotics
NSAIDs
Sumatriptan
Barbiturates
Benzodiazepines
Prevention
Beta-adrenergic agents
Calcium channel blockers
Antidepressants
Anticonvulsants
5HT antagonists
Non pharmacologic
Avoiding certain foods = trigger (cheese, red wine, citrus, MSG)
Avoiding certain smells (cigarette smoke, perfumes)
Stress management
Cluster headaches
Unilateral pain orbitally, supraorbitally, temporally
15-180 minutes
1 every other day to 8x per day
Pain is associated with what in cluster headaches
Lacrimation
Nasal congestion
Rhinorrhea
Forehead and facial sweating
Mitosis
Ptsosis
Eyelid edema
Cluster headache facts
Attacks occur in series, lasting weeks/months separated by remission - months to years
10% chronic
Men 6:1
Orofacial pain
Third decade
Attacks in sleep
Unnecessary dental procedures
Primary mechanism - central
Tx of cluster headaches
Pharmacologic - steroids, oxygen, ergotamine
Chronic paroxysmal hemicrania
Attaches with same characteristics as cluster but shorter, more frequent, females, nsaids use effective
70% women, onset 30 yrs
Pain = unilateral, localized temple, forehead, eye, occipital region
Pain may b referred to as tooth
5-20 minutes
Tension type headache
Dull, non pulsating pain
Pts = tightness, pressure, soreness
Tightness head band feeling
Mild/mod intensity
90% pain bilaterally
Occipital, parietal, temporal, frontal
63% men, 86% women
40% history
Tension type headache facts
Episodic - avg 12 hrs
Duration - 30 min to 72 hours
Onset - 20-40 yrs
Last more 15 days month = chronic
Nausea, vomiting, photo and phonophobia = rare in episodic but common in severe
Precipitating factors for tension type headache
Emotional stress, anxiety, depression, myofascial pain
Sleep deprivation, snoring, weather changes, menstruating
Analgesic abuse - rebound headache
Masticatory muscle activity
Tx tension type headache
Pt education
Identify factors
Decrease caffeine, alcohol, meds chronically used
1st they can increase, but after 1/2 weeks should subside
Pt = assessed for stressors
Tricyclic anti depressants helpful
Manage muscle disorders
Headaches upon awakening = bruxism
Day - pt = cognitive awareness
Postural, stretching/strengthing exercising programs
