headaches 2 Flashcards
what type of headache?
pressing, nonpulsitile , usually bilateral
tension
what type of headache?
usually unilateral, pulsating moderate to severe pain., aggravated by normal activity like walking.
*may have associated sx of nausea, vomiting, photo or phonophobia
migraines without aura
mostly males 3:1
+ family history
what type of headache?
occurs with or after an aura ie: feeling of dread or anxiety, GI upset, visual or olfactory alteration
Migraine with aura
If aura lasts longer than one hour consider alternate Dx
what type of headache?
Occur daily in a group or cluster, may last weeks or months.
often located behind one eye, sharp stabbing pain.
ipsilateral (same side) autonomic signs ie: lacrimation, conjunctival injection, ptosis, and nasal stuffiness.
Cluster headache
Type of headache intervention for primary headaches
avoiding triggers like chocolate, alcohol, cheeses, MSG, artificial sweeteners, little sleep, stress.
lifestyle modifications
Type of headache intervention for primary headaches
NSAIDs and APAP
abortive analgesics
Type of headache intervention for primary headaches
migraine-specific: triptans, ergot derivatives
abortive
avoid in pts who are pregnant or have poorly controlled HTN
Maybe useful in tension-type headaches that do not respond to analgesics
Type of headache intervention for primary headaches beta-blockers, triptylines (tricyclic antidepressants), AED like depakote, topiramate, and lithium (specific to cluster headache
prophylaxis,
indicated when headaches occur > 3 x week, 2 or more migraines a month with symptoms lasteing more than 3 days.
Type of headache intervention for primary headaches
nutritional supplements like butterbur, feverfew, Coenzyme Q10 , magnesium and ribflavin
prophylaxis
type of headache uses lithium for prevention
(specific to cluster headache
Katie is a 33 yo woman who reports a ten year history of unilateral, pulsating headache that lasts at 6 and up to 24 hours, occurring 3-4 times a month. the headache is typically preceded by a gradual onset of paresthesia affecting the ipsilateral face and arm, which lasts about 20 minutes. She reports severe photophobia and phonophobia as well as left chephalgia during the headache. She states the headaches appear randomly. KAties presentation is consistent with? MIgraine with aura tension type headaches cluster headache intracranial lesion
Migraine with aura
not concerned with neurological sx as they only last 20 minutes and this is less than an hour.
The 10 year history is also reassuring
As a result of her headaches, Katie typically needs to either call in sick or leave work early at least once a month. Katie has used OTC medications with partial relief of pain but continues photo-phonophobia. She is currently headache-free and her neurological exam is WNL. Given Katie’s exam, you prescribe which of the following? choose all that apply…
An oral triptan
Migraine prophylactic therapy
An oral NSAID
A short course of a systemic corticosteroid
oral triptan as it is good for photo-phonophobia
Migraine prophylaxis due to the frequency of her headaches
An oral NSAID for the pain
Katie asks if she needs any tests to see what causes the headaches. You respond that she should: Have a head CT Keep a headache diary for the next month Be promptly referred to a neurologist have a head MRI conducted
Keep a headache diary
Do not order unnecessary testing
When do you order a head CT w/o contrast?
acute severe headache with neurological symptoms present
Will show hemorrhage/stroke
When do you order CT with contrast?
If an abscess or tumor is suspected
