Headaches Flashcards
Red flags for headaches
First or worst
Abrupt onset
Fundamental pattern change
New headache pattern when
– ≤5 years old
– ≥50 years old
Cancer, HIV, pregnancy
Abnormal physical exam
Neuro symptoms ≥ one hour
Headache onset:
– with seizure or syncope
– with exertion, sex or valsalva
Comfort signs for headache
Normal physical exam
Stable pattern
Long-standing history
Family history of similar headaches
Consistently triggered by:
– Hormonal cycle
– Specific foods
– Specific sensory input: Light or Odors
– Weather changes
large meta-analysis reports that 0.18% of patients with migraine and normal Neurologic
exam will have significant intracranial pathology, this means
we have Secondary headaches that are a presentation of something else, make sure to do proper workup of headahe
Headache is idiopathic with no identifiable underlying pathology
No diagnostic test
Defined by clinical symptomatology
Diagnosis based on ruling out pathology
Primary Headache
- Headache is symptom reflecting underlying pathology
- Diagnostic tests available
- Diagnosis based on defining pathology
Secondary headache
Causes of Primary headache
- Migraine
- Cluster
- Tension-type
Causes of secondary headache
- Traumatic (e.g. TBI) • Vascular (e.g. SAH) • Infectious (e.g. sinusitis)
- Metabolic (e.g. CO poisoning)
- Oncologic – Primary – Secondary
- Inflammatory (e.g. Giant Cell Arteritis)
What do all the below structures have in common?
Meningeal arteries
Proximal portions of the cerebral arteries
Dura at the base of the brain
Venous sinuses
Cranial nerves 5, 7, 9, and 10, and cervical nerves 1, 2, and 3
Pain sensitive intracranial structures
Pt comes in with recurrent migraines, normally DO NOT get CT or MRI unless:
– Recent change in headache pattern
– New onset seizures
– Focal neurologic signs or symptoms
____of Headache Seen in Primary Care Practices (PCP) Medical Offices is Migraine and ____of Patients in PCP Waiting Rooms have Migraine with _____ of migraneurs undiagnosed
~75%
33%
50%
_____ Women has Migraines
____ Households has a Migraine Sufferer
1 in 5
1 in 4
These types of headaches are brief: may see 1 every other day up to 8 per day and are SEVERE, Unilateral orbital/supraorbital/temrporal and last 15-180 mins
Cluster headaches
Cluster headaches have characteristic UNIlateral orbital/supra/temporal headahce for 15-180 mins and one of which types of symptoms
Conjucntival injection, miosis, ptosis, lacrimation, eyelid edema, rhinorrhea, congestion, forehead/face swelling
so bacially weird eye/nose/face stuff
We may see pain around one eye, along with drooping lid and tearing or conjestion on same side as pain
Horner sydrome associated with Cluster headaches
To be Dx with headaches without aura, you must have at least 5 of them, they last 4-72 hrs and have two of the following:
unilateral location
pulsating quality
moderate or severe intensity
aggravated by walking up stairs/physical activity
You must have at least ONE associated symptom to have dx of migraine w/out auras. These are:
Nausea
vomitting
photophobia/phonophobia
What three features are most predictive of diagnosis with migraines
Nausea
disability
photophobia
What is a fortification specra with partial scotoma
fancy way to describe aura that sometimes preceeds migraines
last 15-20 mins, sometimes see brief seizures; all aura have + visual elements thus its a HYPERexcitable state
To be Dx with tension-type headaches, you must have a head that lasts
hours or may be continous
We need two descriptors of tension headaches to dx; what are they?
What associated findings are seen in tension headaches?
no more then ONE!!!
photo/phonophobia
mild nausea
**no moderate or severe nausea nor vomitting
Weird way to describe tension headache
Stress as associated event
Location: Tension Headache as Premonitory Symptom
If neck pain 82% get Tension Headache diagnosis
75% reported neck pain with their migraine
43% described neck pain as bilateral and 57% as unilateral
69% described the neck pain as “tightness” and 17% as “stiffness”
