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NBB1 > Headaches > Flashcards

Headaches Flashcards

1
Q

Primary Headaches

A 
No apparent cause other than headache onset
-Migraines
-Trigeminal autonomic cephalgias
-Tension headaches
90% of headaches
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2
Q

Secondary Headaches

A

Caused by another disorder, headache is symptom

  • Sinus headaches
  • intracranial mass
  • Low CSF pressure headaches
  • Benign Intracranial HTN
  • Chiari Malformation
  • Neuralgia
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3
Q

Migraine symptoms

A

Unilateral (but not side locked)

  • Pounding/throbbing
  • photophobia/phonophobia
  • Nausea/vomiting
  • typical 4-24h
  • Aura: before migraine onset. Classic scomata (lights bars, flashing). Can see in acephalgic migraine (aura but no headache)
  • Worsen with activity
  • Want to lie in dark room
  • Common Fx migraines, Hx motion sickness
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4
Q

Migraine Triggers

A
  • Stress/lack of sleep
  • skipping meals
  • dehydration
  • bunch of foods including MSG
  • hormonal changes (menses, birth control, pregnant)
  • medications (nitroglycerin)
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5
Q

Migraine Drugs (treat after onset)

A

NSAIDs, anti-emetics, triptans, ergots

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6
Q

Status Migrainosus

A

Migraine >72h

-can require ER visit

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7
Q

Transformed Migraines

A

Migraine–>episodic headache

episodic<15d, 15

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8
Q

Tension Headache

A

Most common

  • bilateral
  • pressure/tightening feeling, squeezing like band
  • lasts mins-days
  • Basically opposite of migraine- not worse with activity, no nausea but can have photo/phonophobia
  • tender to palpation
  • episodic/chronic
  • chronic women>men
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9
Q

Trigeminal Autonomic Cephalgias

A

Defined by unilateral trigeminal-innervated area pain and autonomic symptoms (eye watering/redness/drooping). Include

  • Cluster Headaches
  • Hemicrania
  • SUNCT (Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing)
  • SUNA (Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms)
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10
Q

Cluster Headaches

A
  • Unilateral
  • 1-8 attacks per day, lasts weeks/months, then remission for months/years
  • max orbitally, temporally
  • restlessness/agitation
  • excruciating boring pain, cant sit still (want hit head against wall)
  • men>women
  • Accompanied by autonomic symptoms: lacrimation, nasal congestion, eyelid edema, facial sweating + flushing, “fullness” in ear, miosis, ptosis, Horner syndrome

Unlike migraines:

  • no prodrome/aura
  • awaken patient in night so insomnia-ish
  • periodic (same time of year/day)
  • smoking/alcohol makes worse
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11
Q

Cluster Headache treatment

A

Abortive: O2, lidocaine, octreotide
Preventative: bunch, verapamil
Transitional: trigeminal n. block, steroids

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12
Q

Hemicrania

A

Unilateral headache, always same side/region. Time varies

  • Paroxysmal
  • Continua
  • SUNCT
  • SUNA
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13
Q

Paroxysmal Hemicrania

A
  • Severe unilateral pain
  • orbital/temporal
  • lasts minutes, but many times/day
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14
Q

Continua Hemicrania

A

Incessant (>3mo) severe side-locked headache that only responds to indomethacin

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15
Q

SUNCT

A

Moderate-severe unilateral pain

  • orbital/trigeminal distribution
  • lasts seconds-minutes
  • stabbing/sawtooth pattern
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16
Q

SUNA

A
  • attacks last 7d-yr, remission for months. Multiple/day
  • Only lasts seconds-minutes
  • Autonomic involvement (
17
Q

Indomethacin-responsive headaches

A
  • Paroxysmal Hemicrania
  • Cough-induced
  • Ice-picking (Stabbing)
  • SUNA
18
Q

New Daily Persistent Headache

A

acute onset, chronic headache (kinda mix tension-migraine)

  • daily, unremitting
  • bilateral, tightening, non-pulsating
  • can have photo/phonophobia and nausea
  • headache >3mo
  • mild/moderate intensity
  • not aggravated by activity
  • distinguish from chronic tension headache- chronic from outset, no Hx of headaches
19
Q

Primary Stabbing Headache

A

Icepick Headache- feels like stabbing head at one point

  • Usually V1 region
  • Lasts seconds, reoccurs irregularly, 1-many/day
  • can move
  • no autonomic involvement
  • unilateral/bilateral
  • Indomethacin treats!
20
Q

Thunderclap Headache

A

Sudden onset severe headache

  • lasts hours-days, can recurr in week
  • young women with Hx migraines
  • Rule out subarachnoid hemorrhage! or AVM,
21
Q

Sinus Headache (2º)

A

Dull, deep throbbing in center of head

  • worse with bending down, weather, morning. Can improve through day
  • pressure-like pain in specific part of face, sensitive to touch
  • nasal discharge, congestion, fever, malaise, fatigue (if from sinus infection)
22
Q

Medication Overuse Headache (2º)

A

From taking meds >2x/week
-occurs in +15d/mo in patient with pre-existing headache disorder
-Can occur from regular use of anti-headache drugs for months:
caffeine, excedrin, fiorecet. Triptans. Ergotamine. NSAIDs, opiods, other analgesics

23
Q

Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)- 2º

A

Headache from increased ICP, but without CNS/CSF abnormality, maybe from decreased blood outflow

  • Chronic headache with blurred vision, papilledema, tinnitus, diplopia, CN VI palsy, high pressure found on lumbar puncture.
  • Need to rule out other ICP causes first
24
Q

Low CSF Pressure Headache (2º)

A

“Spinal Headache”/”Spinal Leak” after lumbar puncture (or just hole leaking CSF)- due to shift in intracranial vessels from decreased ICP

  • Can be from ruptured Tarlov cyst
  • Only when sitting/standing
  • Treat with fluids/caffeine, patch hole
25
Q

Chiari Malformation Headache (2º)

A

Downward displacement of cerebellar tonsils

  • see syringomyelia (cervical)
  • Upper cervical/occipital headache with valsalva (bad when cough, bend, etc). neck/back pain.
  • Brainstem/SC involvement- can have sensory/motor dysfunction, urinary incontinence
  • cerebellar: ataxia
  • Lots of vision issues
  • Lots of CN X issues (swallowing, gag). Sleep apnea
  • CN VIII: tinnitus, hearing loss, vertigo, nausea
26
Q

Cranial Neuralgia (2º)

A

Neuropathic pain in distribution of CN- brief, sharp stabbing

  • Trigeminal neuralgia (tic douloureux)- W>M, older, linked to MS
  • Glossopharyngeal Neuralgia
  • Occipital Neuralgia
27
Q

Temporal Arteritis (2º headache)

A

Inflammatory arteritis of temporal artery

  • Headache at unilateral temple, jaw claudication (hurts with chewing). Palpate, find hardened temporal a. without pulse
  • Irreversible monoocular vision loss
  • Diagnose with biopsy

NBB1 (11 decks)

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