Headaches

Question 1

When is the typical onset for migraines?

Answer 1

Usually in adolescence or early adult years

Question 2

Which sex is more affected by migraines?

Answer 2

Females

Question 3

What kind of food, if any, may cause a migraine? If so, give examples.

Answer 3

Nitrate-containing foods. E.g. Bacon, ham, salami, hot dogs, lunch meat

Question 4

Migraines: is there usually a family history or not?

Answer 4

There is usually a family history.

Question 5

What are 8 possible “triggers” for migraine to occur?

Answer 5

1. Emotional/physical stress
2. Lack or excess sleep
3. Missed meals
4. Specific foods
5. Alcoholic beverages
6. Menstruation
7. Using oral contraceptives
8. Changes in weather

Question 6

How long do migraine headaches typically last?

Answer 6

2-72 hours

Question 7

List 8 symptoms of migraines. *Tip: OLDCARTS.. LCDSSSSS

Answer 7

1. Unilateral, lateralized location, occurs episodically
2. May be throbbing or dull
3. Build up gradually; lasts for several hours or longer (2-72)
4. Focal neurologic disturbances may precede or occur during the migraine
5. Commonly visual disturbances occur, e.g. field defects, luminous visual hallucinations like stars, sparks, zigzags of light
6. Aphasia, numbness, tingling, weakness, & clumsiness may occur
7. Nausea & vomiting
8. Photophobia and phonophobia

Question 8

What physical exam findings might you discover in a pt with a migraine?

Answer 8

Pt appears ill, neuro exam for focal neuro deficits or findings supportive of tumor

Question 9

Migraines (specifically new onset) labs and diagnostics (list 5).

Answer 9

1. BMP
2. CBC
3. VDRL
4. ESR
5. CT scan of head

Question 10

How would you manage a migraine acute attack?

Answer 10

Rest in dark quiet room; Simple analgesic like ASA may help;
Sumatriptan 6 mg SQ at onset, can repeat in 1 hr up to 3 times/day OR
Sumatriptan 25 mg po at onset

Question 11

For a patient with migraines, you will teach them to avoid _______ and learn _______ management techniques.

Answer 11

triggers

stress/relaxation

Question 12

You would start prophylactic daily therapy if the pt has how many migraines/month?

Answer 12

2-3

Question 13

List drugs used as prophylactic therapy for migraines.

Answer 13

Amitriptyline
Divalproex (Depakote)
Propranolol
Topiramate (Topamax)
Clonidine
Magnesium
Verapamil
Gabapentin (Neurontin)
Imipramine

Question 14

What physical exam findings might be evident on a patient with cluster headaches?

Answer 14

Usually exam normal, maybe red eyes & rhinorrhea

Question 15

Cluster headaches affect mainly affect (women or men)? Of what age group?

Answer 15

Men, middle-aged men

Question 16

Does the patient with cluster headaches usually report a family history of headaches or migraines?

Answer 16

No.

Question 17

Cluster headache causes: OLDCARTS (O, L/C, A, D, S)

Answer 17

O = Onset usually at night, awakens pt from sleep
L/C =Severe UNILATERAL PERIORBITAL pain occurring daily for several hours
A = May happen after alcohol ingestion
D = Usually lasts less than 2 hrs; may be pain free weeks-months between attacks
S = May have ipsilateral nasal congestion, rhinorrhea and eye redness

Question 18

1. Managing cluster headaches…3 options?

2. What therapy usually does NOT work?

Answer 18

1. 100% Oxygen may help
   Sumatriptan 6 mg SQ can be effective
   Ergotamine tartrate aerosol inhalation (Ergostat) may be effective
2. Oral drugs usually unsatisfactory, especially for acute attacks