Headaches Flashcards
Pain sensitive structures of the head
Scalp
Ms of head and neck
Sinuses
Extracranial and intracranial BV
Dura mater
Is when the areas of the brain interpreting the pain
becomes more sensitive
Central sensitization
A symptom of a dse
Serious headaches
Dse on itself
Benign headaches
Danger signs of headaches
Severe, progressive headache
Alteration of consciousness
Fever, neck rigidity
Double vision
Papilledema
Other focal neurological deficits
Types of headaches
Tension-type
Cluster
Migraine c aura
Migraine s aura
Tension-type headaches symptoms
Pressing or tightening pain
Mild or moderate intensity
Pain in both sides
No aggravation of pain by physical activity
Parameters of tension-type headaches
10 or more attacks between 30 minutes to 7 days
Presentations of a person c tension-type headache
No nausea or vomiting.
May be either photophobia or phonophobia
Muscle contraction in tension-type headache is caused by
Stress
Pain creates more..
Ms spasm
Treatments for tension-type headaches
Analgesics
Identify MPS
Ms relaxants
Anxiolytics/Anti-depressants
Most common type of migraine
Migraine s aura
Criteria for classifying migraine s aura
@ least 5 attacks in the last 4 - 72 hrs
Symptoms of migraine s aura
Pulsating pain
Unilateral
Moderate to severe pain
Aggravation by physical activity
Nausea
Phonophobia/Photophobia
Migraine s aura pt must have no Hx of
Trauma
CVA
Neoplasms
Substance withdrawal
CNS infection
Criteria for classifying migraine c aura
Similar to migraine s aura but must have @ least 2 attacks
Aura criteria
Visual/Sensory numbness
Must be before the headache for < 60 mins
Headache should follow aura w/in 60 mins
Fully reversible
Several attacks during a day in a period of weeks or
months, then months to years of no attack; then
cluster headaches daily
Cluster headache
Shooting paroxysmal pain on the muscles of the
face
Trigeminal neuralgia
Progressive headache that worsens with time
Intracranial lesion
Type of pain exhibited in tension-type headaches.
Squeezing or pressing
Type of pain exhibited in migraines.
Pulsating
Frequent migraine
Chronic/Transformed Migraine
Timetable for chronic migraines
Daily or almost daily (>/= 15 days/month)
Head pain (>/= 4 hrs/day)
Criteria for classifying chronic migraine
History of episodic migraine
History of increasing headache frequency with
decreasing severity of migrainous features
Current headache meets HIS migraine criteria
Criteria for Basilar-type Migraine
Fulfills IHS criteria for migraine c aura
Symptoms present in Basilar-type Migraine
Dysarthria
↓ Hearing
↓ LOC
Double Vision
Ataxia
Bilat Paresthesia
Neurologic deficits persist after the headache
Complicated Migraines
present with hemiplegia
Hemiplegic migraine
Either of the eyes’ movement is paralyzed
Opthalmoplegic migraine
Cranial nerves affected in ophthalmoplegic migraine
3, 4, 6
Criteria for classifying ophthalmoplegic mirgraine
Headache overlapping with paresis of one or more CN III, IV, or VI
Parasellar lesion
May have isolated dilated pupil or tadpole pupil
Clinical features of eye headaches
Asthenopia - eye strain
do not occur instantaneously with a visual challenge
Computer eye syndrome
Criteria for cluster headaches
At least 5 attacks of severe pain lasting 15-180 minutes
Attacks occur up to 8 times a day lasting for weeks to months
Pain localizes in the eyes or temples on one side of the head
Treatments for cluster headaches
Oxygen (8-10 mL/min)
Ergotamines (for attacks)
Propanol 40-160 mg
Topiramate
Indomethacin 25-50 mg TID
Seen c acute sinusitis
Sinus headaches
Sinus headaches clinical presentation
Dull pressure
Bilateral, pre-orbital
Radiating to ears
Usually worse in the morning
Not associated c nausea, vomiting, or visual disturbances
Presents c purulent discharge
Acute sinus headache
Managing migraines
Fight or avoid triggers
Abort the pain ASAP
Prevent frequent attacks
Common migraine triggers by rank
1 - stress
2 - hormones
3 - strong odor
