Headaches Flashcards
Classic: lateralized throbbing headache
Diagnosis based on symptom patterns when there is NO evidence of
intracranial pathology
Migraine Headache
When is the typical onset for migraine headaches?
Usually starts in adolescence or early childhood
A “classic” migraine has what distinguishing feature?
Headache with aura
What can the aura of a migraine be?
Aura can be anything: smell, scotomas, geographic lights, etc
List some associated symptoms with a migraine
Anorexia
Nausea/vomiting
Photophobia
Phonophobia
Blurred vision
Visual disturbances
Numbness/tingling
Clumsiness
Dysarthria
Disequilibrium
Osmophobia
Cognitive impairment
List some triggers for migraine headaches
Emotional stress
Physical stress
Lack of sleep
Excess of sleep
Missed meals
Alcohol
Menstruation
OCPs
Barometric pressure change
Specific Foods
What is the first line treatment for migraine headaches?
Simple analgesics
What line of medication is last line and why?
Opioid analgesics - Last line as they can cause rebound headaches
What Migraine Variant is described below:
Blindness or visual disturbances
Dysarthria, disequilibrium, tinnitus and perioral/distal paresthesia’s
Transient loss of consciousness
Throbbing headache, usually occipital region with N/V
Basilar artery migraines
Most common primary headache type is what?
Tension Headache
Generalized headache
Described as “band-like” or “vise-like” pain
Tension Headache
The following is associated with which type of headache?
Poor concentration
Neck and posterior head pain
No focal neurological deficits
Tension Headache
What factors can exacerbate a tension headache?
Emotional stress
Fatigue
Noise
glare
What are the characteristics of a tension headache?
Poor concentration
Constant daily headache – vise like or tight sensation
Usually generalized, most intense in neck or back of head (base of skull)
Without neurologic symptoms
Often develops during the course of the day
What is the first line treatment for tension headaches?
Simple analgesics
What is the first line treatment for migraine headaches?
Severe, unilateral periorbital headache
Middle-aged men most commonly
No family history
Episodes often occur at night, however can occur at any time, can occur several times in one day
Cluster Headache
There are times that remission of cluster headache does not occur, this is called
Hemicrania continua
List some triggers of a cluster headache
Alcohol
Stress
Glare
Specific foods
List some associated symptoms you can see with a cluster headache
Severe unilateral periorbital pain with one or more:
Ipsilateral nasal congestion
Rhinorrhea
Lacrimation
Redness of eye
Horner’s syndrome
How is the diagnosis of cluster headaches made?
Diagnosed by symptomology
Exclude intracranial pathology
What route of medication is typically ineffective in cluster headaches
Oral medications are usually ineffective
Disturbance in brain function caused by direct or indirect force to the head (Functional rather than structural injury)
Rapid onset of short-lived impairment of neurologic function that resolves
spontaneously
Concussion
Most common symptom in a concussion
Headache
When should you obtain imaging studies in a concussion?
LOC,
evidence of skull fracture
focal neurological deficits
cervical spine injury
What is the imaging of choice in a concussion?
CT brain without contrast is modality of choice
List some associated symptoms with a patient who has a concussion
Emotion instability
Nausea
Vomiting
Scintillating scotomas
Disequilibrium
Impaired memory
Poor concentration
What is the key initial management of a concussion?
Complete cognitive and physical rest are key in initial management
Type of headache caused by coughing, laughing, sneezing, straining
Usually on lasts for a few minutes or less
Primary Cough Headache
Describe the cause of a lumbar puncture headache?
Caused by the leakage of CSF through the dural puncture site
What are the most common causes of a lumbar puncture headache?
Most common cause is large needle or non-compliance (not lying down for 3 hours post-stick)
What are the characteristic features of a lumbar puncture headache?
Dull, throbbing headache
May last for several days
Worse with standing, better with lying down
What is the treatment for a lumbar puncture headache?
IV fluids/caffeine
Blood patch
What are two methods to help prevent a lumbar puncture headache?
Using a small needle
Lies prone post procedure
