Headaches Flashcards
PE manuever where patient is placed in supine position, their leg is flexed at hip and knee. The leg is then extended while you keep the hip flexed
Kernig’s Sign, indicates meningeal irritation if pain occurs
PE manuever that is positive when flexing the patient’s neck causes flexion of the patient’s hips and knees
Brudzinski’s Sign, indicates meningeal irritation
Most common type of headache
tension headache (“muscle contraction headaches”)
Type of headache that usually starts in the back of the head and is characterized by a feeling of a tight band around the head that lasts for a long period of time
tension headache (“muscle contraction headaches”)
Common psychological etiologies of tension headaches
anxiety, stress, depression
Prescription med for tension headaches
Muscle relaxant- Robaxin.
Prescription meds for prevention of tension headaches
Amitriptyline and Topiramate
An episodic headach disorder characterized by neurologic, GI, and autonomic changes
Migraines
Caused by spasm of vertebral vessels. Pain caused by subsequent dilation of extracranial arteries
Migraine headaches
Sx include: no aura, throbbing/pulsating, aggravated by activity, N/V, photophobia or phonophobia
Common migraine
Sx include: scintillating scotoma prior to HA, aura, throbbing/pulsating, N/V, photophobia or phonophobia, aggravated by activity
classic migraine
Sx include: Lateralized pain, N/V, DIPLOPIA, Involves CN III, VI, and lasts more than a couple of days
Ophthalmoplegic migraine
Type of migraine characterized by bilateral visual disturbance, ataxia, dysarthrias
Basilary migraine
First line of tx for moderate to severe migraines
Triptans
Name the three more common triptans
Rizatriptan (Maxalt), Zolmitriptan (Zomig), Sumatriptan (Imitrex)
CI for triptans
coronary vasospasm, IHD, CV disease, >65yrs
Which triptan has the fastest onset of action?
Rizatriptan (Maxalt)
Which triptan suppresses the inflammation of a migraine?
Zolmitriptan (Zomig)
Which triptan has the most options for drug delivery?
Sumatriptan (Imitrex)
Gold standard for prevention of pain and associated symptoms or recurrent headaches
Propanolol (Inderal). Except for smokers > 60yrs
Type of headache that is more rare, but the most severe. Can last days-months, then subside. Attacks can be provoked by ETOH.
Cluster Headaches
Headache that may involve pain around one eye, along with drooping of the lid, tearing and congestion on the same side as the pain
Cluster headache
Syndrome characterized by combination of drooping of the eyelid (ptosis) and constriction of the pupil (miosis). Seen with cluster headaches
Horner’s syndrome
First line tx for cluster headaches
triptans, oxygen or both
Pharm prophylaxis for cluster headaches
Verapamil
Hemorrhage charactized by thunderclap headaches
and Worse headache of life
subarachnoid hemorrhage
Syndrome of elevated ICP frequent in obese patients associated with papilledema and pulsatile tinnitus
Idiopathic Intracranial Hypertension (IIH) (aka pseudotumor cerebri)
Pharm tx for IIH
acetazolamide (Diamox)
Sx include: HA, fever, weight loss, jaw or tongue claudication, visual impairment, temporal pain
Giant Cell Arteritis (Temporal Arteritis)
Diagnostics that should be done for suspected Giant Cell Arteritis(Temporal Arteritis)
ESR and temporal artery biopsy for confirmation
Tx for Giant Cell Arteritis(Temporal Arteritis)
steriods
Sx include: HA, blurry vision, halos, intense eye pain, N/V
acute angle glaucoma
