Headaches 2 Flashcards
migraines with aura tend to occur in who?
females
how do migraines with aura usually present?
unilateral throbbing headaches that are preceeded by an aura
the prodome of a migraine with auraconsists of what?
a progressively increasing scotoma (blind spot) surrounded by flashing lights lasting for about 30 minutes
triggers for migraines with aura
sleeping or eating habits
environmental pollutants
certain medications
food
primary food triggers for migraines with aura
chocolate caffeine nitrates cheese nuts wine etc
what neurological manifestations can be seen with migraines with aura?
aura
olfactory
paresthesias
temporary weakness of facial muscles/limbs
how long do migraines with aura last?
4-72 hours
migraines without auras are usually..
female
what do patients complain of with a migraine with aura?
unilateral, pulsatile headache that is recurrent, having begun as a young adult
what neurological signs and symptoms are associated with migraines without aura?
there are none
what is unique about migraines without aura?
the headache is severe, but they can still function
what can relieve the migraine without aura?
vomiting (sometimes)
are migraines more common with or without auras?
without
what is the management for migraine without aura?
same as migraine with aura
how will a patient describe a tension type headache?
frequent occurence that is often worse in the afternoon or early evening
where is the pain for a tension headache?
bilateral in the suboccipital or supraorbital region
are tension headaches due to muscle tension?
no, there is no higher incidence of muscle hypertonicity with tension headaches
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
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
cervicogenic headache is due to?
referral from soft tissues and articular structures in the neck
cluster headaches occur in who mostly?
middle aged men
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
what is the average frequency of cluster headaches?
several times per day, often at night, lasting for one to several weeks
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
does chiropractic help those with cluster headaches?
not clear
what can be helpful in those with cluster headaches?
electrical stimulation of hypothalamus
similar treatment to migraine with oxygen therapy
who does temporal arteritis occur in?
patients older than 50
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
what do you do with people with temporal arteritis?
immediate referral (because blindness can result)
how is temporal arteritis treated?
corticosteroids
what is elevated in temporal arteritis?
ESR and C reactive proteins
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
what are the two types of stroke?
ischemic*
hemorrhagic
what do you do with someone who you suspect is having a stroke?
FAST face drooping arm weakness slurred speech time counts (911)
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
sentinel headache
sudden, intense and persistene, preceeding spontaneous subarachnoid hemorrhage by days or weeks
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
papilledema
optic swelling that is secondayry to elevated intracranial pressure
what happens to vision with papilledema?
nothing, usually well preserved acutely
what will you see in someone’s eye if they have papilledema
obliteration of physiologic cup
tortuous vessels
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
brain tumor symptoms
headaches seizures sensory and motor loss hearing loss vision loss fatigue depression behavioral and cognitive changes endocrine dysfunction
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
symptoms specific to the location of the tumor
pressure or headache near the tumor
symptoms specific to a tumor of a cerebellum
loss of balance and difficulty with fine motor skills
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)
pineal gland tumr
inability ot look upward
pituitary tumor
lactation and altered menstrual periods in women
growth in hands and feet in adults
brain stem tumor
difficulty swallowing, facial weakness or numbness, double vision vision changes (temproal, occipital lobe, brain stem)
most prevalent brain tumor types
gliomas (glioblastoma multiforme, ependymomas, astrocytomas, oligodendrogliomas)
meningiomas
most prevalent tbrain tumor types on children
astrocytoma
medulloblastoma
ependymoma
