headache part 1 Flashcards
other term for headache
cephalalgia
pain in sinus headaches
behind browbone and/or cheek bones
pain in cluster headaches
in and around one eye
pain in tension headache
like a band squeezing the head
presentation of migraines
pain, nausea, and visual changes are typical of classic form
percentage of adult population with active headache disorders
46% - headache in general
11% - migraine
42% - tension
3% - chronic daily headache
where is pain from distention of the middle meningeal artery projected
back of the eye and temporal area
where is pain from intracranial segments of ICA and proximal parts of MCA and ACA projected
eye and orbitotemporal regions
sphenopalatine branches of the facial nerve is from
nasoorbital region
what are the pain-insensitive structures in the head
- brain parenchyma
- ependyma
- choroid
- pia
- arachnoid
- dura over convexity
- skull
what are the mechanisms of headaches
- intra/extracranial artery distention, traction, dilation
- traction/displacement of large intracranial veins and their dural envelope
- compression, traction, or inflammation of cranial (CN II, III, V, VII, IX, X) and spinal nerves
- meningeal irritation and increased ICP
deform, displace, or exert traction on vessels and dural structures at the base of the brain even before there is inc ICP
intracranial mass lesion
presentation of headaches caused by increased ICP
bioccipital/bifrontal headaches that fluctuate in severity and worse in supine
what can cause dilation of intracranial/extracranial arteries and possible sensitization
seizures, alcohol ingestion, nitroglycerine and nitrates, MSG
this is the throbbing or steady headache wherein increased pulsation of meningeal vessels activate the pain sensitive structures within their walls or around the base of the brain
febrile illness
this mechanism of cranial pain present with extremely rapid rise in BP, along c cough & exertional headaches
dilation of intracranial or extracranial arteries
projection of basilar artery thrombosis
occiput
where does ICA dissection and MCA occlusion project to
ipsilateral eyebrow, forehead above
T/f: most strokes d/t vascular occlusion does not cause head pain
true
sever, persistent headache localized on the scalp then becomes diffused
extracranial temporal & occipital arteries (giant cell arteritis)
pain from ethmoid and sphenoid sinuses projection
localized deep in the midline behind the root of the nose or occassionally at the vertex
paranasal sinus infection or blockage present where?
over the affected sinuses
type of sinusitis wherein pain is worse upon awakening and gradually subsides when upright
frontal and ethmoid sinusitis
description of hypermetropia and astigmatism
sustain contraction of extraocular, frontal, temporal, and occipital muscles
described as rapid amelioration p corrective lenses
EORs
give causes of meningeal irritation
infection or hemorrhagr
headaches of meningeal irritation is due to
inc ICP, dilation & inflammation of meningeal vessels and chemical irritation of pain receptors in large vessels and meninges by endogenous chemical agents
the two endogenous chemical agents in meningeal irritation
serotonin and plasma kinins
described as intense, sudden headaches associated c vomiting & neck stiffness
subarachnoid hemorrhage
steady occipitonuchal and frontal pain coming on within a few mins after arising from recumbent position; relived within a minute or two by lying down
lumbar puncture and spontaneous low CSF pressure
Traumatic cause of LP and spontaneous low CSF pressure headache
persistent leakage of CSF into lumbar tissues through the needle tract or a tear of the meninges
spontaneous cause of LP and spontaneous low CSF pressure headache
cough, sneeze, strain, athletic injury, result of rupture of arachnoid sleeve along a nerve root
CSF pressure is low, often 0 in what position
lateral decubitus position
LP and spontaneous low CSF pressure headache is relieved by what
epidural blood patch
subdural hematoma headache
dull and unilateral, perceived over most of the affected side of neck
headaches aggravated by lying down can happen in
subdural hematoma
brain mass, esp posterior fossa
idiopathic intracranial hypertension
idiopathic intracranial hypertension headache description
global and nuchal, generally worse in supine
headaches that are typically worse in the early morning after a long period of recumbency
increased ICP headaches
cranial pain that are usually benign but may be associated c pheochromocytoma, AVM, and other intracranial lesions
exertional headaches
description of primary headaches
- headaches and associated features constitute the disorder itself
- pain is the only identifiable disease
- no underlying cause
- migraine, tension-type, cluster, trigeminal-sympathetic variant
- chronic, recurrent
- unattended by other symptoms or signs of neurologic disease
secondary headaches description
- headache results from exogenous causes
- glaucoma, sinusitis, SAH, meningitis, trauma, vascular disease
- headache d/t psychiatric disorder
- only 1% of pts c brain tumor will have headache as sole complaint
HA c sudden onset c maximal severity in seconds or minutes
subarachnoid hemorrhage
HA is gradual over hours or days
meningitis
onset in early morning or daytime, peaks over several to 30 mins, and lasts for 4-24 hrs or longer
migraine
occurrence of severe unilateral orbitotemporal pain coming on within 1-2 hrs p sleeping or at predictable times during the day and recurring nightly/daily for a period of several weeks to months
cluster headache
qualities of headaches
tightness, aching, pressure, burning, bursting, sharp, stabbing
pulsating/throbbing headaches are usually pertaining to what
migraine
factors of comprehensive and precise history in assessing headaches
- onset
- timing
- variation over time
- quality/character
- laterality
- location
- severity/intensity
- change
- associated Sx
- cranial autonomic features
- premonitory features
- triggers
- aggravating and alleviating features
- family Hx
- lifestyle features
headache that is unilateral in 2/3 of attacks, commonly associated c nausea, vomiting, and sensitivity to lights, sounds, and smells
migraine
location of temporal arteritis
site of vessel
location of pain in paranasal sinuses, teeth, eyes, upper cervical vertebrae
less sharply localized pain but referred to a single region usually the forehead, maxilla, or eyes
location of pain in intracranial lesions in posterior fossa
ipsilateral if one-sided lesion; occipitonuchal pain
location of pain supratentorial lesions
frontotemporal pain that approximates the site of lesion
location of pain in periorbital and supraorbital pain
ocular disease, dissection of cervical portion of the ICA
this reflects the pt’s temperament, attitudes, and customary ways of experiencing and reacting to pain
severity/intensity
under what component of history is asking the disability and interference with activities, and propensity to awaken from sleep
severity/intensity
sensory hypersensitivity, N&V, visual changes, numbness/tingling of face/extremities, focal motor weakness, speech impairment, light-headedness/vertigo, cognitive dysfunction
associated symptoms
lacrimation, conjunctival injection, periorbital or facial edema, ptosis, pupillary changes, nasal congestion or rhinorrhea, aural fullness of tinnitus
cranial autonomic features
triggers or precipitating factors of headaches
menstrual cycle, skipping meals, lack of sleep or oversleeping, stress or relaxation from stress, altitude or barometric changes, position changes, valsalva, physical exertion, bright lights, smells, alcohol, caffein, certain food
generalized, mild headache occurring regularly in premenstrual period
catamenial migraine
intense HA after a period of inactivity, first movements are painful and stiff
cervical spine disease
medications/food that may cause headaches
nitroglycerin, dipyridamole, MSG
Complete PE and NE consists of
- bruits of head and neck
- temporal artery tenderness and pulsations
- pupillary size and symmetry
- funduscopic examination
- visual field testing
- EOMs
- facial sensation
- motor function
- dentition and bite, TMJ
- cervical and shoulder musculature
headache c acute & recurrent pattern
migraine (c or s aura)
headache c chronic & nonprogressive pattern
- tension type HA (TTH)
- anxiety
- depression
- somatization
headache c chronic & progressive pattern
- brain tumor/space occupying lesion
- benign intracranial hypertension
- hydrocephalus
- CNS infections
headache c acute/chronic & non-progressive pattern
- TTH c coexistent migraine
red flags in headaches
- systemic signs/sx and systemic diseases
- neurologic Sx
- older
- onset
- pattern change
red flags under systemic signs/Sx and systemic disease
- stiff neck
- vomiting
- fever
- night sweats
- rash
- myalgia
- wt loss
- pregnancy/postpartum
- comorbid diseases
- malignancy
- AIDS
red flags under neurologic Sx
- change in level of consciousness
- papilledema
- diplopia
- loss of sensation
- weakness
- ataxia
- local tenderness (temporal artery)
- valsalva maneuver
- disturbs sleep or presents immed upon awakening
- h/o seizure, collapse, or loss of consciousness
red flags under older and onset categories
- new onset p 50 y/o
- sudden and/or first ever
- severe/worst headache of life
- thunderclap headache (reaches max intensity in an instant)
red flags under pattern change
- change in frequency, severity, or clinical features of the attack
- subacute worsening over days/wks
- accelerating pattern
- continuous/persistent
- pain triggered by sexual activity, valsalva, or sleep
- worsening during change in position
in the approach to headache, what is the headache’s classification if there are red flags
secondary headache -> diagnostic testing
