Headaches 1-3 Flashcards
1
Q
Primary headaches
A
migraine tension cluster
2
Q
secondary headaches
A
caused by underlying organic disease
3
Q
cervicogenic headaches
A
secondary although some classify as primary
4
Q
abnormal findings with headaches warrant what?
A
neuroimaging to rule out intracranial pathology
5
Q
what is the preferred method to rule out hemorrhage?
A
CT
6
Q
MRI is necessary for imaging what?
A
posterior fossa
7
Q
what are CSF analyses for?
A
hemorrhage infection tumor CSF disorders
8
Q
headache onset after 50 years is?
A
a red flag
9
Q
ddx for headaches beginning after 50 years
A
temporal arteritis mass lesion
10
Q
possible work ups for headaches beginning after 50
A
ESR/CRP, neural imaging
11
Q
ddx for sudden onset headache
A
subarachnoid hemorrhage mass lesion vascular malformation
12
Q
possible workup for sudden onset headache
A
neuroimaging lumbar puncture if neuroimaging is negative
13
Q
ddx for increased frequency and severity of headache
A
mass lesion subdural hematoma medication overuse
14
Q
possible workup for increasing frequency and severity of headache
A
neuroimaging drug screening
15
Q
red flags considering headaches
A
>50 years sudden onset increase in frequency and severity HIV/cancer systemic illness (fever, stiff neck, rash) focal neurological S&S papilledema subsequent to head trauma
16
Q
ddx for headache from HIV/cancer
A
meningitis abcess metastasis
17
Q
possible workup for headache from HIV/cancer?
A
neuroimaging lumbar puncture if neuroimaging is negative
18
Q
ddx for headaches from systemic illness
A
meningitis encephalitis lyme disease systemic infection collagen vascular disease
19
Q
possible workup for headaches from systemic illness
A
neuroimaging lumbar puncture serology
20
Q
ddx for focal neurological S&S
A
mass lesion vascular malformation stroke collagen vascular disease
21
Q
possible workup for headaches from focal neurological S&S
A
neuroimaging collagen vascular evaluation
22
Q
ddx for a headache with papilledema
A
mass lesion meningitis
23
Q
possible workup for headache with papilledema
A
neuroimaging lumbar puncture
24
Q
ddx for headache from subsequent trauma
A
intracranial hemorrhage subdural/epidural hematoma posttraumatic headache
25
possible workups for headaches from subsequent trauma
neuroimaging of the brain, skull and possibly cervical spine
26
migrain pain location
unilateral
27
tension headache pain location
band like and bilateral
28
cluster headache location
strictly unilateral
29
temproal arteritis headache location
distribution of temporal artery
30
trigeminal neuralgia pain location
distribution of trigeminal nerve
31
acute glaucoma pain location
eye pain
32
what is one of the most common cause of headaches?
whiplash
33
4 primary headache patterns
migrain tension type cluster headache cervicogenic
34
when must acute headache be evaluated?
if associated with neurologic S&S
35
describe a migraine
associated with nausea, vomiting, or sleepliness and separated by pain free intervals
36
what is a chronic progressive headache? What may be suspected?
severity and frequency increase over time structural disorder of CNS
37
what is a chronic nonprogressive headache?
most typical type, usually related to stress
38
most patients presenting to physician's office for evaluation of headache have what?
either a tension headache or migraine
39
S&S of a migraine
nausea photophobia phonophobia exacerbation by physical activity aura
40
intracranial organic pathologies are from what?
infection intracranial mass lesion hemorrhage hypertensive parenchymal hemorrhage, subdural hematoma ischemic conditions traumatic brain injury
41
other organic syndromes
cluster headache cranial bone pain scalp pain vascular involvement eye pain ear pain acute sinusitis dental pain facial nerve pain neck pain acute febrile illness metabolic disorders
42
red flags for headaches
sudden, severe headache new headache, older patient headache due to head trauma associated residual neurologic S&S cognitive changes vomiting w/o nausea persistent or progressive headache nuchal rigidity with or without fever suspicion of drug or alcohol dependance headache associated w' 15-mm Hg persistent/severe headache in child
43
headaches associated with exertion may mean
underlying tumor or vascular weakness
44
when do you do a CT/MRI for post traumatic headaches?
signs of neurological dysfunction and loss of consciousness
45
most primary headaches occur when?
at an early age and are recurring
46
when should a new headache be a concern?
if they are middle aged or older complaining of a new headache
47
older patients with a temporal headache need to be considered to have..
temporal arteritis
48
headaches that are constant and more severe without reprieve likely indicate
intracranial process and should necessitate a referral for evaluation
49
how to manage a headache without red flags
modify patient behavior (sleep, diet, exercise) manage with CMT supplements or herbal alternates nonpharmacological treatments, if chiro is unsuccessful (acupuncture/biofeedback) refer for medical management if still unsuccessful
50
migraines with aura tend to occur in who?
females
51
how do migraines with aura usually present?
unilateral throbbing headaches that are preceeded by an aura
52
the prodome of a migraine with auraconsists of what?
a progressively increasing scotoma (blind spot) surrounded by flashing lights lasting for about 30 minutes
53
triggers for migraines with aura
sleeping or eating habits environmental pollutants certain medications food
54
primary food triggers for migraines with aura
chocolate caffeine nitrates cheese nuts wine etc
55
what neurological manifestations can be seen with migraines with aura?
aura olfactory paresthesias temporary weakness of facial muscles/limbs
56
how long do migraines with aura last?
4-72 hours
57
migraines without auras are usually..
female
58
what do patients complain of with a migraine with aura?
unilateral, pulsatile headache that is recurrent, having begun as a young adult
59
what neurological signs and symptoms are associated with migraines without aura?
there are none
60
what is unique about migraines without aura?
the headache is severe, but they can still function
61
what can relieve the migraine without aura?
vomiting (sometimes)
62
are migraines more common with or without auras?
without
63
what is the management for migraine without aura?
same as migraine with aura
64
how will a patient describe a tension type headache?
frequent occurence that is often worse in the afternoon or early evening
65
where is the pain for a tension headache?
bilateral in the suboccipital or supraorbital region
66
are tension headaches due to muscle tension?
no, there is no higher incidence of muscle hypertonicity with tension headaches
67
clinical features of tension headaches
bilateral headache mild to moderate intensity pressing or tightening quality (non-pulsating) non aggravated by routine physical activity absence of nausea and vomiting may have photophobia or phonophobia, but NOT BOTH
68
pure cervicogenic headache without overlap can present as?
daily headaches with no associated neurological signs one sided reduced neck motion in the neck helps associated with neck pain
69
cervicogenic headache is due to?
referral from soft tissues and articular structures in the neck
70
cluster headaches occur in who mostly?
middle aged men
71
what are the S&S of a cluster headache?
incredibly painful unilateral, orbital in location occur over days or weeks and then reappear again several weeks or months later history of smoking an possible alcohol use
72
what is the average frequency of cluster headaches?
several times per day, often at night, lasting for one to several weeks
73
what might the patient experience during a cluster headache?
lacrimation associated with a runny nose on the same side as the headache agitated and animated beat head against wall for relief they may attempt suicide
74
does chiropractic help those with cluster headaches?
not clear
75
what can be helpful in those with cluster headaches?
electrical stimulation of hypothalamus similar treatment to migraine with oxygen therapy
76
who does temporal arteritis occur in?
patients older than 50
77
what might the patient complain of with a tempral arteritis headache?
unilateral headache in temporal region tender nodule at the superficial temporal artery on side of forehead generalized aching and muscular tatigue int he upper trunk visual dysfunction or blindness of sudden onset
78
what do you do with people with temporal arteritis?
immediate referral (because blindness can result)
79
how is temporal arteritis treated?
corticosteroids
80
what is elevated in temporal arteritis?
ESR and C reactive proteins
81
what S&S would make you want to do advanced imaging on a headache patient
worsening with fever sudden onset w/ max intensity at 5 minutes new onset neurologic deficit or cognitive dysfunction change in personality impaired level of consciousness trauma within last 3 months headache from cough, valsalva or sneeze triggered by exercise orthostatic headache symptoms suggestive of giant cell arteritis, or acute glaucoma substantial change in characteristics of their headache
82
what are the two types of stroke?
ischemic\* hemorrhagic
83
what do you do with someone who you suspect is having a stroke?
FAST face drooping arm weakness slurred speech time counts (911)
84
S&S of a hemorrhagic stroke
worst headache of my life extremely sudden onset if the doc can't distinguish between migraine or tension type preceeded by sentinel\*\*\* headache in a lot of patients
85
sentinel headache
sudden, intense and persistene, preceeding spontaneous subarachnoid hemorrhage by days or weeks
86
warning signs of a potential dissection
sudden onset of headache, neck pain, face pain pain that is different than patient has experienced before 5Ds And 3Ns Dizziness Drop attacks Diplopia Dysarthria Dysphagia Ataxia Nausea Numbness Nystagmus
87
papilledema
optic swelling that is secondayry to elevated intracranial pressure
88
what happens to vision with papilledema?
nothing, usually well preserved acutely
89
what will you see in someone's eye if they have papilledema
obliteration of physiologic cup tortuous vessels
90
what are the intracranial structures that are pain sensitive?
meningeal arteries proximal protions of cerebral arteries dura at the base of the brain venous sinuses CN 1, 2, 3, 5, 7, 9
91
brain tumor symptoms
headaches seizures sensory and motor loss hearing loss vision loss fatigue depression behavioral and cognitive changes endocrine dysfunction
92
describe the headaches of people who have brain tumors
steady pain, worse upon waking, better in a few hours persistent, progressive, non migraine aggravated by valsalva maybe vomiting maybe throbbing maybe worse with coughing, exercise or change in body position doesn't respond to regular headache remedies maybe associated with new neurologic findings
93
symptoms specific to the location of the tumor
pressure or headache near the tumor
94
symptoms specific to a tumor of a cerebellum
loss of balance and difficulty with fine motor skills
95
symptoms specific to a tumor of the cerebrum
changes in judgement loss of initiative, sluggishness, muscle weakness, paralysis (frontal lobe) partial or complete loss of vision (occipital or temporal lobe of cerebrum) changes in speech, hearing, memory, or emotional state (aggressiveness)(frontal and temporal lobe of cerebrum) altered perception of touch or pressure, arm or leg weakness on one side of the body or confusion with left and right sides(frontal or parietal lobe)
96
pineal gland tumr
inability ot look upward
97
pituitary tumor
lactation and altered menstrual periods in women growth in hands and feet in adults
98
brain stem tumor
difficulty swallowing, facial weakness or numbness, double vision vision changes (temproal, occipital lobe, brain stem)
99
most prevalent brain tumor types
gliomas (glioblastoma multiforme, ependymomas, astrocytomas, oligodendrogliomas) meningiomas
100
most prevalent tbrain tumor types on children
astrocytoma medulloblastoma ependymoma
101
normal measurement for sella turcica
16 across x 12 depth on a 40" film
102
if the sella turcica is large, it could be?
empty sella tumor normal aneurysm
103
most common symptom of chiari malformation
headache that begins at the back of the head and radiates upward made worse by coughing, sneezing or straining
104
other common symptoms of chiari malformation
dizziness vertigo disequilibrium visual disturbances ringing in ears difficulty swallowing palpitations sleep apnea muscle weakness impaired fine motor skils chronic fatigue painful tingling of hands and feet
105
chiari measurement
vertical distance from tip of cerebellar tonsils to a line drawn betwen and anterior and posterior margins of the foramen magnum normal less than 3mm
