Headache & Other Craniofacial Pain Flashcards
What is the diff betw primary & secodnary headaches?
Primary = headache IS THE disorder/disease itself
Secondary = identified exogenous causes
What are the 3 most important types of headache?
Migraine
Tension-type headache = most common
Trigeminal autonomic cephalalgias (cluster headache)
What are the casues of 2ndary headaches?
Trauma/injury to the head & or neck
Cranial or cervical vascular disorder
Non-vascular intracranial disorder
Meningitis, subarachnoid hemorrhage, glaucoma, brain tumor, hypertension, etc
What awhat are the most common causes of primary & secondary headache?
Primary = tension type
Secondary = systemic infection
What re the pain-producing structures in the head?
Scalp
Meningeal arteries
Dural sinuses
Falx cerebri
Proximal segments of the large pial arteries
Brain parenchyma IS NOT PAIN-SENSITIVE
In general PE of headaches, what should u emphasize on?
Paransal sinus tenderness = t/c sinusitis
Palpation of the eys = t/c INC IOP
Neck rigidity = t/c meningitis & subarachnoid hemorrhage
Inspection & palpation of temporal arterities = t/c temporal enteritis
What condition is a recurring syndrome of headache assoc w/ OTHER SYMPTOMS OF neurological dysf w/ other admixtures?
Migraine
What are the 2 types of migraine?
Migraine with aura
Migraine without aura
What are the NT affected in migraine?
5HT (serotonin)
Dopamine
What are the diff attack phases of migraine?
Aura
Headache phase
Premonitory (prodromal)
Postdrome
What are s/sx of Prodromal phaes of migraine?
Neck discomfort
Yawning/sleepiness, polyuria/polydypsia, mood change, fatie, cognitive impairment
What are S/Sx of Aura phase of migraine?
Scintillating scotoma
What are s/sx of headache phase of migraine?
Pain
Nausea/vomiting
Sensory sensitivity
What are s/sx of postdrome phase of migraine?
Tiredness
Weakness
Concentration impairment
What are pharmacologic agents used for acute attacks of migraine?
Analgesics (Acetaminophen)
NSAIDs
Sumatriptan
What are prophylaxis for migraine?
Beta-blockers (propranolol)
Antidepressants (amitriptyline)
Anticonvulsants (topiramate, valproic acid)
Calcitonin gene-related protein
What should be given as tx if a patient has 4 or more attacks per month or poor response to acute tx?
Propanolol and Flunarazine
what are the most effective drug for acute migraine atatcks?
Triptans
what are the s/sx of Tension-Type headache?
bilateral, tight, band-like
episodic or chronic (15 days or more in a month_
builds up slowly and fluctuates
“muscle contraction headache”
what are tx of tension-type headache?
acetaminophen
NSAIDs
Amitriptyline = anti-depressant, for chronic types
whatr are the diff types of trigeminal autonomic cephalalgias?
cluster headache
paroxysmal hemicrania
short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing
short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms
what are cranial autonomic symptoms?
lacrimation
conjunctival injection
aural fullness
nasal congestion
what are s/sx of cluster headache?
periodicity (<1 yr)
stabbing and excruciating pain
retro-orbital in location
what causes cluster headache?
disorder of central pacemaker neurons
neurons in the posterior hypothalamus
what are abortive tx for Cluster headache?
Sumatriptan injection/nasal spray
Oxygen
Zolmitriptan nasal spray
what is a sign that headache is caused by subarachnoid hemorrhage?
anteflexion of the neck or
slightest nuchal catch
intraparenchymal bleeds will show focal signs
what are signs that secondary headache is caused by meningitis?
fever
headache
neck rigiditiy
what are signs that secondary headache is caused by epidural or subdural hematoma?
depressed sensorium outweighs focal deficits
what are signs that secondary headache is caused by brain tumor?
chronic progressive headache that worsens over time
what are signs that secondary headache is caused by purulent sinusitis?
sinus tenderness
what type of craniofacial pain involves painful, lancinating, sudden pain in 1/2 of the face with excruciating pain in the lips, face, and gums?
Trigeminal neuralgia
what are diff dx of Trigeminal neuralgia?
SUNCT and Trigeminal Autonomic cephalgia
Diseases of the jaw, teeth and sinuses
Temporal arteritis
Multiple Sclerosis
Compressive lesions of CN V
What is the best tx given to px with Trigeminal neuralgia?
Carbamazepine or Tegretol
can also do:
Microvascular decompression (relieves pressure)
Gamma knife
Radiofrequency Thermal rhizotomy (comp: numbness)
