Headaches Flashcards
Migraine
Greater than 5 attacks lasting at least 4 hours At least 2 of the following: Unilateral Pulsating Moderate severity aggravated by physical activity
Can be associated with nausea, vomiting, photophobia, phonophobia
Migraine Aura
Lasts 5-20 minutes. Disappears with onset of headache
Treatment for migraines with psych comorbidities
Sleep hygiene, exercise, avoiding EtOH, CBT, Biofeedback, TCAs (more than SNRIs)
Childhood Migraines
Shorter, bilateral often, more severe, responds to Tylenol and NSAIDs (unlike in adults)
Basilar Type Migraine
Ataxia, vertigo, dysarthria, or diplopia
Hemiplegic Migraine
Hemiparesis of various grades
Familial Hemiplegic Migraine
Autosomally dominant migraine
Food-induced Headaches
Migraine sufferers should avoid 4 Cs: Chocolate, cheese, ….
But there is an intense craving for these foods.
Med-induced HA
Nitroglycerine, Isosorbide, others
Sex or exertion related HAs
Propranolol or Indomethacin prophylactically can help
Acute Tx of Migraine
CBT relaxation techniques, opiates (but risk rebound), Triptans, Ergotamine, DHE, Reglan (for nausea), parenteral meds if can’t take PO
Preventative Treatment of Migraines
Antidepressants, antihypertensives, and _________. TCAs; Topiramate, Valproate,
Chronic Daily Headaches
Most likely due to Medication overuse (triptans and opiates). Commonly Fiorinal, NSAIDs, Benzos.
Cluster HA
45-90 min. Intense searing pain behind one eye. Eye tearing. Nasal congestion. Partial Horner Syndrome. Severe. 1-8 attacks per day for month then remits (they come in clusters)
Cluster HA Treatment
Most meds don’t work. Sumatriptan + OXYGEN, + DHE injection can abort it. Especially O2.
Temporal Arteritis
Autoimmune. Dull and constant pain in temporal region. Can cause sudden blindness
Intracranial masses
Subdural hematomas, etc
Chronic Meningitis
Can cause facial palsy, hearing loss, extra ocular palsies.
Pseutotumor Cerebir
Papilledema and blind spots; Compressed/small ventricles on MRI
Subarachnoid Hemorrage
Worst HA of your life; Sudden; CT can reveal. Do CT before Lumbar tap so you don’t cause herniation;
MAOIs and hypertensive crisis
MAOIs can react with tyramine rich foods or other medications to cause this. Phentolamine can reverse it. Chlorpromazine and Propranolol can help.
Trigeminal Neuralgia
Impingement of the nerve. Stabbing pains. Tx is Carbamazepine; Surgical interventions now.
