Headaches Flashcards
3 most common primary headaches
- Migraine 2. Cluster 3. Tension headache
Closed head injury severity based on 2 findings
- Presence/absence of LOC
2. Presence/absence of neurological signs
Mild TBI
- None - brief LOC, dilated pupils, flaccid mm. slowed hr
- Recovery in seconds-minutes
- Days to weeks of giddiness, anxiety, headaches, poor concentration
Moderate TBI
- S/S: Unconscious up to an hour
- Slower recovery of behavior & orientation
- Lethargic 1-7 days, agitation, anxiety
- CT scan normal or show signs of contusion
- Tx: hospitalization & rest
Severe TBI
Categorized by pt response vs injury
Tx: Hospitalization required
TBI severity grading scale
- Grade I: confusion, sx last 15min, no LOC
3. Grade III: LOC seconds-minutes
TBI Red Flag Symptoms
- unconsciousness
- altered mental status
- convulsions
- extremity weakness
- bleeding from ear
- persistent HA
- loss of hearing
Post concussion syndrome
sx persist for years
HA, fatigue, dizziness, memory/attention problems, sleep disturbances
Classifications of headaches
- primary or secondary
2. vascular or non-vascular
Secondary headaches (examples)
Caused by underlying medical condition
head/neck trauma, infection, substance use/withdrawals, psychiatric conditions, crania neuralgia (trigeminal & glossopharyngeal), etc.
Vascular Headache
Quality of pain: throbbing or pounding
Various triggers lead to change in artery size
triggers (migraine, cluster, fever, HTN, hangover, exertion)
Non-vascular headache
Quality of pain: Steady, dull, aching
tension type, ear ache, TMJ, sinus infection
History taking w/ c/o of headache
L- location M- mechanism N- new O - onset P - provocation/palliation Q - quality R - Radiation S - Severity T - timing Concomitants
Red Flags on history
Onset after age 50 Increase in severity & frequency Sudden onset pain moves to lower neck & thoracic First or worst headache H/o of head trauma, HIV, CA Any changes in mental status, personality, level of consciousness
Physical exam for headache
Vitals
Cervical ROM, carotid & temporal a. pulsation
Oral & ear exam
Tenderness of mm of head & neck
Palpate cranium, jaw, sinuses
neurological exam
HEENT exam (fundoscopic exam important to check for papilledema)
Red flags on Physical Exam
Fever Neck stiffness/rigidity Papilledema Focal neurological signs Signs of systemic illness or infection
Migraine - Epidemiology
Frequency: 2nd most common
Sex: F:M 3:1
Age: 1st incidence in childhood, increases in adolescence
Migraine - Triggers
Stress Female hormones hypoglycemia loss of sleep change in weather conditions exercise food intolerance tyramine-containing foods
Migraine - Classifications
- Migraine with aura
2. Migraine without aura
Migraine without aura
Diagnostic Criteria: (at least 5 attacks with the following)
1. HA lasting 4-72hrs
2. 2 of the following
Unilateral location
pulsating quality
mod-severe pain
worse with routine activity
3. During headache at least 1 of following occurs
nausea/vomiting
photophobia and phonophobia (fear of loud noises)
Migraine with aura
May be prodromal symptoms prior then diagnostic criteria (at least 2)
Visual
Sensory
Dysphasic
aura develops 5-20min lastScreening test for migraine
> 90% accuracy at detecting migraine
- Has a headache limited your daily activity for a day or more within the last 3 mo.?
- Are you nauseated or sick to your stomach when you have a headache?
- Does light bother you when you have a headache?
Tension type headache - epidemiology
Sex: F:M 2:1
Age: all ages, mostly young adults
Triggers: stress & mental tension
Tension type - Classifications
- Infrequent episodic - episode less than 1 day a mo.
- Frequent episodic - episode 1-14 days a mo.
- chronic - headaches 15 or more days a mo.
