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clin med III, exam 3 > headaches > Flashcards

headaches Flashcards

1
Q

List the two types of primary headaches (occur independently)

A
  • vascular
  • muscle contraction -> tension type
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2
Q

List the two types of vascular headaches

A
  • migraine
  • cluster
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3
Q

List the two types of secondary headaches (associated with another disorder)

A
  • traction
    • organic diseases of the head (ex: intracranial mass)
  • inflammatory
    • ex: meningitis
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4
Q

what is the most important factor in establishing a diagnosis for headache

A

headache history

  • frequency
  • duration
  • intensity
  • location
  • quality
  • time and setting of onset
  • aggravating/alleviating factors
  • age of onset
  • associated sx
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5
Q

clinical presentation

  • throbbing, pulsating, typicall unilateral
  • duration: 4-72 hours
  • +/- photophobia, phonophobia, N/V
  • movement makes it worse
A

Migraine

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6
Q

List the two main types of Migraines

A
  • migraine without aura (“common”)
  • migraine with aura (“classic”)
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7
Q

what type of migraine is this

  • visual aura, vertigo, dysarthria, ataxia, decreased level of consciousness, syncope, tinnitus, hypacusis (hearing impairment)
A

migraine with brainstem aura (“Basilar”)

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8
Q

what type of migraine is this

  • visual loss or disturbance in one eye
A
  • retinal migraine
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9
Q

what type of migraine is this

  • unilateral HA with oculomotor palsy
  • diplopia, ptosis, dilated pupil
A
  • ophthalmoplegic neuropathy
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10
Q

what type of migraine is this

  • hx of episodic vertigo with hx of migraines
A

vestibular migraine

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11
Q

what type of migraine is associated with menstrual cycle

A

menstrual migraine

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12
Q

what type of migraine is this

  • temporary paralysis
  • familial component
A

hemiplegic migraine

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13
Q

what type of migraine is this

  • rare, severe disabling migraine lasting > 72 hours
  • requires hospitalization
A

status migrainosus

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14
Q

how long does an aura last both before the HA comes on and total time

A
  • visual and/or other neurological sx 10-60 min prior to HA
  • aura last less than 60 min
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15
Q

What is the premonitory symptoms phase of migraine

A
  • 24-48 hours prior to HA
  • food craving, mood change, uncontrollable yawning, fluid retention, inc urination, neck stiffness
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16
Q

what are the positive symtoms of an aura

A
  • visual
  • auditory
  • sensory
  • motor
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17
Q

what are the negative symtoms of an aura

A
  • loss of function, vision, hearing, sensation, or motor
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18
Q

what is characteristic about the onset of a migraine

A

builds gradually in intensity

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19
Q

postdrome phase of migraine may be associated with

A
  • confusion
  • exhaustion
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20
Q

describe the sensory aura associated with a migraine

A
  • unilateral tingling (face, limb)
  • abnormal sensations
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21
Q

define cutaneous allodynia

A
  • abnormal pain response from things like combing hair, shaving, wearing glasses, contact lens, earrings, tight fitting clothing
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22
Q

how are migraines diagnosed

A
  • history and physical exam
  • no imaging necessary
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23
Q

what are clinical scenarios involving HA that warrant imaging

A
  • “worst headache of my life”
  • changes in HA presentation
  • new or unexplained neurologic symptoms
  • HA not responding to treatment
  • new onset after 50 or in pts with CA or HIV
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24
Q

what imaging is recommended in evaluation of HA

A

CT

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25
Q

acute migraine tx

A
  • decrease triggers
  • rest in dark quiet environment
  • cool cloths on forehead
  • fluid
  • caffeine in early stages
  • meds
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26
Q

first line medications/abortive for mild/moderate migraine

A
  • oral NSAIDs, acetaminophen or OTC combination (excedrin, midrin)
  • N/V -> add antiemetic
27
Q

first line medications/abortive for moderate/severe migraine

A
  • triptans and Ergots
    • ​oral triptans or combination with NSAID (sumatriptan, naproxen)
28
Q

side effects of Triptans

A
  • “Tripton sensation”
    • chest pressure, weakness, dizziness, paresthesia
    • resolve in 30 min
29
Q

contraindications to Triptans and Ergotamine

A
  • these meds are vasoconstrictors
    • uncontrolled HTN
    • pregnancy
    • Hx of MI, Cerebrovascular disease, peripheral vascular disease
30
Q

List the three medications that are first-line for preventative migraine management

A
  • propranolol (B-blocker)
  • amitriptyline (TCA)
  • Topiramate (anticonvulsant)

*consider co-morbidies when choosing

31
Q

clinical presentation

  • bilateral pressure, band-like
  • mild-moderate intensity
  • duration 30 min-7 days
  • anorexia, head/neck pain with muscle tenderness, bruxism (grinding teeth)
  • no N/V
A

tension type headache

32
Q

list common triggers for tension type headache

A
  • stress
  • jaw clenching
  • missed meals
  • depression
  • too little sleep
  • head/neck strain
33
Q

criteria for infrequent episodic tension type headache

A
  • < 12 days/ year
  • lasting < 1 day/month
34
Q

criteria for frequent episodic tension type headache

A
  • 10-14 days/month
  • lasting 30 min to several days
35
Q

criteria for chronic tension type headache

A
  • > 15 d/month
  • lasts hours to days
  • may be unremitting
36
Q

how are tension type HA diagnosed

A
  • history and clinical presentation
37
Q

treatment for tension type HA

A
  • NSAIDs
    • high initial dose
38
Q

cluster headaches are commonly seen more in what patient population

A

Men

39
Q

cluster headaches are associated with what

A
  • Trigeminal autonomic cephalgias (TACs): sharp, boring, unilateral, periorbital HA with autonomic sx
40
Q

duration of cluster headaches

A
  • brief, 15-180 minutes
41
Q

how often can cluster headaches come on

A
  • attacks: every other day - 8x/day
  • clusters: typicallly 6-12 weeks
42
Q

remission period for cluster HA

A

up to 12+ months

43
Q

chronic cluster headache

A
  • clusters lasting > 1 year or remission < 1 month
44
Q

are cluster headaches associated with a certain time of day

A
  • come on similar time of day/night
45
Q

autonomic sx of cluster headache

A
  • parasympathetic hyperactivity and sympathetic impairment
    • lacrimation
    • eyelid edema
    • nasal congestion
    • rhinorrhea
    • facial sweating
    • miosis
    • ptosis
  • ***ipsilateral to pain
46
Q

triggers commonly associated with cluster headache

A
  • alcohol
  • smoking
  • stress
47
Q

how is cluster headache diagnosed

A
  • history and clinical presentation
  • MRI with and without contrast
    • to evaluate brain and pituitary gland
48
Q

treatment of acute cluster headache

A
  • Oxygen: nonrebreathing facemask 100% O2 at 12 L/min
    • sitting upright
    • continue x 15 min
  • triptan: subcutaneous sumatriptan
49
Q

preventative medication for cluster headache

A
  • start at onset of cluster episode
  • CCB: Verapamil
50
Q

criteria for chronic daily headache

A
  • > or = 15 days/month during 3+ months
51
Q

list four types of chronic daily headaches

A
  • chronic migraine
  • chronic tension type
  • hemicrania continua
  • newly daily persistent headache
52
Q

clinical presentation

  • continuous, fluctuating pain on same side of face/head lasting minutes-days
  • associated sx: tearing, irritated eyes, rhinorrhea, swollen eyelids
A

hemicrania continua

53
Q

tx of hemicrania continua

A

indomethacin and/or corticosteroids

54
Q

clinical presentation

  • pain ranges mild-severe: throbbing/tightening on both sides of head
  • associated sx: light/sound sensitivity
  • may occur following infection, medication use, trauma, or other condition with no previous hx or headache
A

newly daily persistent headache

55
Q

clinical presentation

  • “ice pick” or “jabs and jolt” headache
  • pain is intense and strikes without warning
  • lasts 1-10 seconds
  • may occur anywhere along trigeminal nerve
  • occur daily-yearly
A
  • primary stabbing headache
56
Q

triggers associated with primary exertional headache

A
  • coughing, sneezing, intense activity
57
Q

imaging recommended for primary exertional headache

A
  • MRI/MRA to r/o vascular abnormalities
58
Q

clinical presentation

  • “alarm clock headache”
  • occurs later in life (> 50 yo)
  • develops during sleep and awakens people at night
  • > 10 episodes/month lasting 15 min-3 hours
A

hypnic headache

59
Q

treatment for hypnic headache

A
  • caffeine at night > indomethacin > lithium
60
Q

What is the SNOOP checklist for secondary headaches

A
  • Systemic sx or illness (fever, weight loss)
  • Neurologic (focal sx, decreased LOC)
  • Onset sudden
  • Older (new onset > 50 yo)
  • Previous HA hx (1st HA or change in HAs)
61
Q

clinical presentation

  • sx increase with cough, exertion, straining, position
  • papilledema, vision loss, pulsatile tinnitus
A
  • CSF pressure
    • idiopathic intracranial hypertension
62
Q

clinical presentation

  • abrupt severe headache
  • “thunderclap headahce”
  • decreased LOC, nuchal rigidity
  • first and worst HA
A

subarachnoid hemorrhage

63
Q

clinical presentation

  • primary HA develops or worsens with medication overuse
  • typicall preceeded by an episodic HA disorder
  • high risk: opioids, barbituates, aspirin, acetominophen
  • HA often occurs when analgesic is withheld
A

medication overdose headaches

clin med III, exam 3 (6 decks)

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