Headaches

Question 1

% of migraines w/o aura?

Answer 1

80%

Question 2

typical average duration of migraine?

Answer 2

7-12 hours

Question 3

which headache is band-like?

Answer 3

tension

Question 4

typical trigger of cluster headache?

Answer 4

often alcohol

Question 5

diagnostic criteria for tension headache?

Answer 5

must present with 2 of the following:

• pressing or tightening (non pulsating)
• B/L - mild/moderate intensity
• not aggravated by physical activity

Question 6

diagnostic criteria for cluster headache?

Answer 6

• excruciating, stabbing, lancinating pain
• U/L: periorbital, retro-orbital, temporal (can radiate to cheek, jaw, occiput, nuchal regions); pain along trigeminal nerve
• sudden onset, peaks at 10-15 mins
• lasts 5 mins to 3 hours
• 1-8x / day for as long as 4 months
• often nocturnal
• sx free intervals: 2 mos to 20 yrs

Question 7

labs to run when red flags present?

Answer 7

CBC - systemic or intracranial infection
ESR - suspected temporal arteritis
CT or MRI - r/o intracranial pathology
CSF - suspected hemorrhage, infection, tumour or other concerns related to CSF

Question 8

headache red flags?

Answer 8

• first or worst headache ever
• neurological symptoms
• valsalva
• neck stiffness
• change in personality, LOC, mental status
• middle age or later onset
• sudden onset
• rapid and severe
• systemic symptoms
• worsening symptoms
• changing features

Question 9

specific questions to ask with regard to headache?

Answer 9

• accompanying muscle tension
• how long does it last without tx?
• why come in for this particular headache?
• new medications?
• triggers?
• menses?
• sleep quality and duration
• depression & anxiety

Question 10

what is the Cerena Transcranial Magnetic Stimulator?

Answer 10

• 1st FDA-approved device for migraine with aura
• adults >18yoa
• do not exceed 1 tx/24hrs
• delivers pulse of magnetic energy
• stimulates occipital cortex
• 39% of patients pain-free for 2 hrs after use

CI: metal in head, neck or upper body; active implanted medical device; suspected/diagnosed epilepsy or seizures

Question 11

effect of caffeine additives on pain relievers

Answer 11

• caffeine additives seem to make pain relievers 40% more effective
• seems to help absorb headache drugs more quickly

Question 12

“main” homeo headache remedy?

Answer 12

nat mur

Question 13

R sided homeo Headache remedies (5)

Answer 13

belladonna
sanguinaria 
agaricus 
iris 
lycopodium

Question 14

L sided homeo headache remedies (3)

Answer 14

bryonia
lachesis
sepia