Headaches Flashcards
MC types of recurring headaches?
Tension and migraine
Headache red flags
SNOOP Systemic symptoms Neurologic symptoms Onset (suddent, abrupt) Older Previous HA history
Most important tool for an accurate diagnosis of HA?
Comprehensive history
Key features of HA history
- Onset
- Location
- Frequency and timing
- Severity
- Quality of pain
- Associated features (e.g. last eye exam)
Mainly which cranial structures are pain sensitive?
Vascular
Is the brain pain sensitive or insensitive?
Insensitive - EXCEPT distention of aqueduct of Sylvius and wall of the 4th ventricle
S/S of vascular headaches
- Pulsatile in quality
- Intensified by motion of head
- Occasionally transient flashes of light or stars
Migraine pathophys theory
- Hereditary, paroxysmal disorder of CNS
- Includes episodes during which there is a phase of decreased cerebral blood flow and a phase of extracranial arterial dilation
Migraines are a disorder of what?
Brain excitability and sensory dysmodulation with vascular changes
Classifications of migraines
- Common (w/o aura)
- Classic (w/aura)
- Migraine equivalent (focal neuro disturbances w/o HA or vomiting in 40-70 yo)
- Complicated
Phases of migraine
- Promontory phenomena (may occur hours to days before HA)
- Aura
- HA
- Resolution
What are negative visual symptoms?
Transient hemianopsic defects
What are positive visual symptoms?
Wavy lines, flashes of light, zig zag patterns
Define scintillating scotomas
Negative visual symptoms surrounded by shiny, sparkling figures (positive symptoms)
Treatment of migraines
- Modify trigger factors
- Pharmacotherapy next
Clinical features of tension headaches
- Dull, achy, non-pulsatile
- Bilateral tightness (band-like sensation)
- Usually no N/V
Treatment of tension headaches
- Relaxation techniques
- PT (hands on)
- Pharmacotherapy (acetaminophen, ASA, NSAIDs)
Clinical features of cluster headaches
- Severe unilateral pain (worse than migraines)
- Restlessness, agitation
Epidemiology of cluster HAs
- 4:1 males
- Mean age of onset 27-31 yo
- Increased among family members
Treatment of cluster HAs
- High flow O2
- Sumatriptan (SC/intranasal)
- Zolmitriptan (PO/intranasal)
- Lidocaine (intranasal)
Prophylaxis options for cluster HAs
- Verapamil
- Lithium
- Prednisone
- Ergotamine
- Occipital nerve stimulation
