Headaches Flashcards

1
Q

Primary HA

A

not associated with any other disease
migraine
tension type
cluster

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2
Q

Secondary HA

A
associated with a condition that will not resolve until that conditions is treated
tumor
brain bleed
meds such as nitrates
meningitis
arterities
viremia
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3
Q

SNOOP mneumonic for HA red flags

A
systemic symptoms
neurologic signs
onset sudden
onset > 50 or < 5
previous HA history
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4
Q

systemic symptoms for HAs

A

fever

wt loss

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5
Q

neurological signs for HA

A
confusion
LOC altered
nuchal regidity
HTN
papilledema
cranial nerve dysfx
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6
Q

previous HA history for HA

A

onset of different HA

change in pattern or severity

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7
Q

sudden thunder clap HA =

A

subarachnoid hemorrhage

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8
Q

Tension type HA characteristics

A
30 min - 7 days
pressing, nonpulsatile pain
mild to mod intensity
bilateral
more female than male
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9
Q

Migraine w/o aura characteristics

A
4 - 72 hours
pulsating
mod to sev intensity
aggravated by normal activity
unilateral
n/v
photophobia
phonophobia
family hx
more remales
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10
Q

Migraine with aura characteristics

A

focal dysfx of cerebral cortex with causes aura to develop over 4 min
may have feeling of dread or anxiety, fatigue, GI upset, visual or olfactory alteration
no aura should last > 1 hour
family hx

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11
Q

Cluster HA

A

occur daily in groups or clusters
last several weeks to months
occurs often 1 hour into sleep
located behind one eye
crescendo pattern lasting 15 min to 3 hours
ipsilateral signs ( lacrimation, conjunctival injection, ptosis and nasal stuffiness).

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12
Q

Treatment options for HAs

A
lifestyle modification
analgesics
rescue therapy
migraine specific meds
prophylactic or controller meds
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13
Q

lifestyle modification for HA

A

triggers could include chocolate, alcohol, chesses, MSG, perfumes, stress, sleep
get routine exercise

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14
Q

analgesics for HA

A

NSAIDS
tylenol
limit to 2 tx days/wk to avoid rebound HA

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15
Q

rescue therapy for HA

A

opioids, antimetics, corticosteroids

if severe and don’t respond to typical therapy

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16
Q

migraine specific meds for HA

A

Triptans
caution with pregnancy, CV disease, uncontrolled HTN
helpful with tension type HA
used in tx for cluster HA

17
Q

prophylactic or controller meds for HA

A
beta blockers
tricyclic antidepressants ("lines")
antiepiletic drugs (gabapentin)
calproate
topiramate
lithium
butterbur
feverfew
coenzyme Q10
magnesium
riboflavin
18
Q

Criteria for prophylaxis in HA

A

use of any product more than 3 x per week
> 2 migraines per month that last > 3 days
the goal is to reduce HA frequency and severity

19
Q

When to refer HA to specialist

A

has a dx that needs supported or clarified by specialist

fails to respond to tx

20
Q

Avoid with CT if you suspect bleed

A

contrast

21
Q

Use CT for

A

hemorrhage
edema
atrophy

22
Q

Use MRI for

A
tumor
AV malformations
posterior fossa lesions
meningitis
hemorrhage of days to weeks in duration
soft tissues
23
Q

What kind of contraception can cause HA

A

combined estrogen-progestin oral contraceptives

24
Q

When considering EBP for use of prophylactic migraine tx which is the preferred agent

A

propranolol

25
Q

If someone has angina pectoris what should you avoid for abortive migraine therapy

A

ergotamine
almotriptan
these are vasoconstrictors and increase the risk for an MI
verapamil is not used for migraines

26
Q

Initial testing if you suspect giant cell arteritis or temporal arteritis

A

Sed rate

depending on this result an arterial biopsy can be done as difinative dx

27
Q

Tx for someone with arteritis

A

long term high dose corticosteroids

28
Q

foods to avoid with HA

A
sour cream
ripened cheese
sausage meets
pizza
chicken liver
herring
fermented foods
MSG
yeast products
chocolate
nuts
beans
onions
figs
bananas
caffeine
alcohol
aspartame
29
Q

what are some lifestyle triggers for migraines

A
menses
pregnancy
intense exercise
altered sleep pattern
altered eating
lights
odors
weather
altitude
SSRIs, SNRIs
contraceptives