Headache (HA) Flashcards
Recognize the epidemiological implications of headache
50% visits with HA c/o and 15% of US population seeking care
$50 Billion/year missed work + medical benefits – US
_____________ 2nd and 3rd most prevalent diseases worldwide
Migraine: 7th most disabling condition of all, 4th in women
TTH and Migraine:
Consider _______ in ER HA
Blood vessels- can be blocked, inflamed, etc
Stimulation of ______ often leads to pain
Trigeminal
______ % Of HA have no known cause
90%
Need to rule out 10% 2o
Episodic Migraine: Criteria
5 episodes, 4 - 72 hours
2 of the following: unilateral, pulsating, moderate or severe, incr w/ physical activity
1 of the following: NV, photo & phonophobia
Botox injections: for chronic migraine
Migraine Aura: Criteria
2 episodes
Reversible s/s of 1 of following:
visual, motor, sensory, brainstem, language, retinal
And 2 of the following: homonymous visual field or unilateral sensory change gradual development >5 min symptom lasts 5-60 min
Migraine: Abortive Treatment
Aspirin, acetaminophen, NSAIDs
Combination:
- ibuprofen/caffeine*/aspirin
- Triptans (e.g. sumatriptan or Imitrex)
- 5-HT 1B/1D agonists - Ergotamine derivative (e.g. DHE)
- nonselective 5-HT agonists
Migraine: Prophylactic Treatment
BB, CCB
Tricyclic Antidepressants
Anti-epileptics
alt: sleep, B2
_____ RX: for chronic migraine
Botox injections
Tension-type HA: Criteria
10 episodes, 30 min – 7 days
2 of: Pressing/ tightening, Mild – Moderate
Bilateral, Not aggravated by PA
Both: No NV, one /none: photophobia or phonophobia
Don’t perform neuroimaging studies in patients with stable headaches that meet criteria for ____________
migraine
Don’t perform computed tomography (CT) imaging for headache when _____________ is available, except in emergency settings.
magnetic resonance imaging (MRI)
Don’t recommend _________ of migraine trigger points outside of a clinical trial
surgical deactivation
Don’t prescribe _________ medications as first-line treatment for recurrent headache disorders.
opioid or butalbital-containing
Don’t recommend prolonged or frequent use of _______________ for headache
over-the-counter (OTC) pain medications
Cluster Headache: Criteria
5 episodes
Severe, unilateral, periorbital and/or temporal,15-180 min
1 every other day up to 8/day
1 of the following:*
conjunctival injection
lacrimation
nasal congestion
rhinorrhea
eyelid edema
ptosis
miosis
facial swelling
ear fullness
restless/agitation
Cluster Headache Epidemiology
Men:Women - 4:1
Triggers
- alcohol
- vasodilators
Cluster HA Treatment
- abortive: oxygen, triptans inj, ergots
preventive: CCB, Lithium*, Antiepileptics - transitional: steroids, nerve blocks
Trigeminal Neuralgia Criteria:
Trigeminal Neuralgia
Idiopathic (primary)
Vascular compression (secondary)
Demyelination – multiple sclerosis (secondary)
• Infection of meninges • S/s – HA – Fever – Stiff Neck – NV – AMS – Kernig/Brudzinski signs
Meningitis
• Most common cause of sudden, intense, incapacitating HA
• Associated symptoms – Stiff neck – Photophobia – Nausea/vomiting – Neurologic findings/obtundation
• Mechanism
– Trauma
– Ruptured aneurysm (80%)
– Arteriovenous malformation
• Up to 50% mortality rate
Subarachnoid Hemorrhage
• Inflammation of vessel wall • Risk Factor: Age >60 years (70-80 yrs) • s/s – Jaw claudication – Temporal artery tenderness – Vision loss (optic nerve infarct) – Joint pain – fever, malaise, wt loss
Giant cell
