Headaches Flashcards
what is the most common complaint of man; more than 1/2 americans report one each year; 1 out of 3 people has had one; can be felt around the eyes ; 1% are high risk
HA
what are most Ha caused by
muscle Cxn or blood flow probs
what are the main types of HA
Tenstion Type ( 78%), migraine ( 16%) , cluster (0.4 %) , and other > primary HA
in this type of HA, pain is in and around the eye
cluster
in this type of HA, pain is like a band squeezing the head
tension
in this type of HA, you get pain nausea and visual changes ( migraine with aura)
migraine
what are some secondary HA caused by
sinus, fasting, infections, stroke, trauma, tumor, hydrocephalus, refractive disorders
what are some red flags for HA
- new type of HA over the age of 50
- HA increased frequency or severity
- HA wakes pt from sleep
- Onset of HA assoc with an underlying medical condition or systemic illness
- HA with neurological symptoms
- HA with papilledema
- HA with altered mental status
this the majority of all HA; dysfunction of pain perception; episodic or chronic changes; more common in women; CNS sensitization due to persistent myofascial input
tension type HA
signs of this type of HA include :bilateral, dull, band like tightness; lasts 4-6 hrs; no photophobia or phonophobia; doesn’t get worse with physical activity
Tension type HA
what are some causes of Tension HA
emotional of physical stress; depression and anxiety; working in awkward positions;; overuse of OTC analgesis
Tx for this type of HA include: OTC NSAIDS, caffeine, exercise, and stress reduction therapy
tension type HA
this type of HA affects females more than men; most prevalent age 25-55; 70% have immediate family Hx; Hx of childhood car sickness, benign vertigo ; strong correlation with depression and anxiety
migraines
what is the neurovascular theory of migraine pathophysiology
lowered threshold to stimuli leads to cortical hyperexcitability> cortical spreading depression activates trigeminal nerves and causes pain in dural blood vessels
T or F: migraines begin in the temporal lobe and move forward
F: begin in the occipital lobe
what are the diff migraine stages
prodrome, aura, attack, and postdrome
this migraine stage happens 1-2 days prior to attack; involves constipation , depression, diarrhea, drowsiness, and irritability
prodrome
this migraine stage happens immediately before attack ; usually visual
aura
this migraine stage is moderate to severe pain; several hrs to 3 days
attack
this migraine stage is malaise and fatigue
postdrome
what are some migraine triggers
stress, head trauma, weather or air pressure changes, bright lighting, meds , smoking, strong odors, fasting, red wine, hormone changes
what are some foods that trigger migraines
tyramine ( yogurts); phenylethylamine ( chocolate, wine); Sodium nitrites, artificial sweeteners, caffeine, MSG, Alcohol, chocolate
what is the 5,4,3,2,1 criteria for migraines
5 or more attacks; 4 hours to 3 days in duration; 2 or more of the following symptoms ( unilateral, pulsating, moderate or severe pain, aggravation by or causing avoidance of routine physical activity ); 1 or more of the following ( nausea or vomiting, and photophobia or phonophobia)
what are the diff types of migraines
migraine w/o aura ( majority), migraine with aura, retinal migraines, childhood periodic syndromes, complication of migraines, probable migraines, chronic migraines
signs of this type of migraine include :improves with sleep, progressivey worsening , unilateral, throbbing pain , nausea and vomiting, anorexia
migraine without aura
T or F: migraines w/o aura increase the risk of stroke and MI by 25%
T
this type of migraine is the classic type ; HA symptoms are the same as migraine w/o aura; aura precedes HA; can have aura w/o HA ( more common in men over 40) ;90% increased risk of stroke and 108% increased risk of stroke
migraine with aura
what type of scotoma do you get with migraine with aura
scintillating scotoma
how do scintillating scotomas come about
- initial paracentral scotoma
- , enlarging scotoma 7 mins later
- scotoma obscuring central vision 15 mins later
- break up of scotoma 20 mins later
these types of migraines are transient, monocular visual disturbances ; usually brief, HA before or after the visual episode ; under age 40;
retinal migraines
caused by vascular spasm which causes an interruption in the ciliary or retinal circulation; DDx is Amaurosis fugax
retinal migraines
what are some ocular manifestations of migraines
aura, hemianopsia, horners syndrome, normal tension glaucoma
this ocular manifestation is the most common cause of transient vision loss under age 45
auras
this ocular manifestation is a persistent VF defects up to weeks after an attack ; VF loss can be permanent
hemianopsia
this ocular manifestation is usually in older adults , association not causation
normal tension glaucoma
what type of Tx would you do if the HA are more than 2 per month
prophylactic Tx
what are the diff prophylactic Tx for HA
beta blockers, antidepressants, epilepsy meds, lithium, Ca channel blockers, Botox
what are the diff abortive Tx
serotonin agents, cerebral vasoconstrictive agents, non constrictive abortive agents , antiemetic drugs ( Phenergan), general pain mgt
this type of HA can have excrutiating,unilateral pain ( orbital, supraorbital or temporal); rare ( 80% are heavy smokers, 50% have Hx of ETOH use/abuse; attacks occur in clusters
cluster HA
this type of HA can last for weeks or monthsl HA lasts 15-180 mins; can occur once every other day for 8x/day
cluster HA
this type of HA involves changes to trigeminal pain processing; some autonomic features include nasal congestion, facial sweating, projectile lacrimation, conj redness, miosis and ptosis
cluster HA
what are some Tx options for cluster HA
verapamil, lithium, divalproex, oxygen, and sumatriptan
what are some ocular causes of HA
angle closure glaucoma, uveitis, keratitis, and scleritis, optic neuritis, refractice disorders and muscle imbalance, metastatic orbital tumors
this is a sharp, stabbing, fleeting pain localized to one eye; occurs along CN V ; often a Hx of migraines; benign; cause unknown
ophthalmodynia periodica
this is acute, unilateral mydriasis ( lasts for a few mins up to 1 week, may have light reaction, women more than men ; Hx of migraines;
benign episodic pupillary mydriasis
this is assoc with blur, photophobia, HA
benign, episodic pupillary mydriasis
this is pain in the trigeminal and faical nerve areas; ages 15-40 YO; more common in females; 5% of population ; originates from the jaw and Is worse than chewing; jaw clicks or locksl manage with dental devices or analgesics
TMJ syndrome
