Headache - J. Prunuske Flashcards
What are the 3 types of primary headaches?
- Tension-type
- Cluster
- Migraine
Who most commonly gets tension-type headaches?
- onset < age 40
- more common in WOMEN
- increased prevalence in people with INCREASED EDUCATIONAL attainment
What is the pathophysiology of tension headaches?
- muscle contraction
- greater occipital nerve compression
- exacerbated by emotional stress
What is the typical clinical presentation of a tension headache?
- 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
What is the management/treatment of tension headaches?
- Analgesics
- Ibuprofen
- Aspirin
- Relaxation techniques
- Massage/Acupuncture
- Biofeedback
Who most commonly gets cluster headaches?
- Male to female ratio = 4:1
- Mean onset age = 27-31
What is the pathophysiology of cluster headaches?
- Not completely understood
- Hypothalamic activation of the trigeminovascular autonomic system
- parasympathetic activation
- Genetic
What is the typical clinical presentation of a cluster headache?
- 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
How should you manage/treat cluster headaches?
- Supplemental Oxygen
- 6-10 liters for 15 min
- Prophylaxis of episodic cluster headaches
- Verapamil
- Melatonin
- Prednisone
- Capsaicin
Who most commonly suffers from migraine headaches?
- 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
What is the pathophysiology of migraine headaches?
- Uncertain
- Possible spreading cortical depression
- Possible NT dysfunction
- NO
- CGRP
- Possible dorsal pontine activation
What is the typical clinical presentation of a migrain headache?
- Gradual onset
- Debilitating pain
- Intermittent
- Unilateral
- Throbbing/pulsating
- Associated with nausea
- +/- Aura
- Last hours-days
- family history of migraine headaches
What two medications do you want to avoid prescribing a patient who suffers from migraine headaches with aura?
- Oral Contraceptive Pills (OCPs)
- Sildenafil (Viagra)
What is the 1st line treatment for migraine headaches?
- Triptans
- Dihydroergotamine (DHE)
- Antiemetics
- Perchlorperazine
- Metoclopramide
- Analgesics
- Acetaminophen
- Ibuprofen
- Aspirin
- Dexamethasone
What is the first line prophylactic medication for migraine headaches?
Amitriptyline
What are headache red flags for possible subarachnoid headache?
- Sudden onset
- severe “Thunderclap” headache
What are headache red flags for ruptured aneurysm?
headache onset with exercise
What are headache red flags of possible temporal arterritis or intracranial mass?
New headache onset after age 50
What are headache red flags for possible meningitis or encephalitis
- Headache with fever
- stiff neck
- photophobia
- systemic signs
What are headache red flags for possible subdural hematoma?
headache onset hours-weeks after trauma
What are headache red flags for possible tumor, subdural hematoma, or epidural bleed?
- Headache with focal neurologic signs
- Symptoms or papilledema
What are headache red flags for possible environmental exposure or carbon monoxide poisoning?
Multiple people with similar new onset headache
(e.g. family, coworkers, etc.)
