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Neuro B2 - WLB > Headache - J. Prunuske > Flashcards

Headache - J. Prunuske Flashcards

1
Q

What are the 3 types of primary headaches?

A
  1. Tension-type
  2. Cluster
  3. Migraine
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2
Q

Who most commonly gets tension-type headaches?

A
  • onset < age 40
  • more common in WOMEN
  • increased prevalence in people with INCREASED EDUCATIONAL attainment
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3
Q

What is the pathophysiology of tension headaches?

A
  • muscle contraction
  • greater occipital nerve compression
  • exacerbated by emotional stress
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4
Q

What is the typical clinical presentation of a tension headache?

A
  • 30 min - 1 week in duration
  • pressing/tightening
  • mild-moderate intensity
  • possible phonophobia/photophobia (not both)
  • BILATERAL
  • Not aggravated by routine physical activity
  • No nausea & vomiting
  • DOES NOT GET IN THE WAY OF LIFE ACTIVITIES
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5
Q

What is the management/treatment of tension headaches?

A
  • Analgesics
    • Ibuprofen
    • Aspirin
  • Relaxation techniques
  • Massage/Acupuncture
  • Biofeedback
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6
Q

Who most commonly gets cluster headaches?

A
  • Male to female ratio = 4:1
  • Mean onset age = 27-31
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7
Q

What is the pathophysiology of cluster headaches?

A
  • Not completely understood
  • Hypothalamic activation of the trigeminovascular autonomic system
    • parasympathetic activation
  • Genetic
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8
Q

What is the typical clinical presentation of a cluster headache?

A
  • Severe, unilateral, orbital/supraorbital/temporal pain lasting 15-180 minutes
  • Circadian periodicity
    • every other day up to 8x per day
  • Autonomic symptoms
    • lacrimation
    • nasal congestion
    • rhinorrhea
    • forehead sweating
    • miosis
    • ptosis
    • eyelid edema
    • conjunctival injection
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9
Q

How should you manage/treat cluster headaches?

A
  • Supplemental Oxygen
    • 6-10 liters for 15 min
  • Prophylaxis of episodic cluster headaches
    • Verapamil
    • Melatonin
    • Prednisone
    • Capsaicin
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10
Q

Who most commonly suffers from migraine headaches?

A
  • Female to male ration = 3:1
  • Onset age < 40
  • Prevalent in 18% of women & 6% of men
  • 20-25% lifetime prevalence in both sexes
  • More than 50% of people with migraines miss 2+ days of work per month
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11
Q

What is the pathophysiology of migraine headaches?

A
  • Uncertain
  • Possible spreading cortical depression
  • Possible NT dysfunction
    • NO
    • CGRP
  • Possible dorsal pontine activation
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12
Q

What is the typical clinical presentation of a migrain headache?

A
  • Gradual onset
  • Debilitating pain
    • Intermittent
    • Unilateral
    • Throbbing/pulsating
  • Associated with nausea
  • +/- Aura
  • Last hours-days
    • family history of migraine headaches
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13
Q

What two medications do you want to avoid prescribing a patient who suffers from migraine headaches with aura?

A
  • Oral Contraceptive Pills (OCPs)
  • Sildenafil (Viagra)
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14
Q

What is the 1st line treatment for migraine headaches?

A
  • Triptans
  • Dihydroergotamine (DHE)
  • Antiemetics
    • Perchlorperazine
    • Metoclopramide
  • Analgesics
    • Acetaminophen
    • Ibuprofen
    • Aspirin
  • Dexamethasone
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15
Q

What is the first line prophylactic medication for migraine headaches?

A

Amitriptyline

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16
Q

What are headache red flags for possible subarachnoid headache?

A
  • Sudden onset
  • severe “Thunderclap” headache
17
Q

What are headache red flags for ruptured aneurysm?

A

​headache onset with exercise

18
Q

What are headache red flags of possible temporal arterritis or intracranial mass?

A

New headache onset after age 50

19
Q

What are headache red flags for possible meningitis or encephalitis

A
  • Headache with fever
  • stiff neck
  • photophobia
  • systemic signs
20
Q

What are headache red flags for possible subdural hematoma?

A

headache onset hours-weeks after trauma

21
Q

What are headache red flags for possible tumor, subdural hematoma, or epidural bleed?

A
  • Headache with focal neurologic signs
  • Symptoms or papilledema
22
Q

What are headache red flags for possible environmental exposure or carbon monoxide poisoning?

A

Multiple people with similar new onset headache

(e.g. family, coworkers, etc.)

Neuro B2 - WLB (13 decks)

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