Headaches Flashcards
Primary Headaches
No apparent cause other than headache onset -Migraines -Trigeminal autonomic cephalgias -Tension headaches 90% of headaches
Secondary Headaches
Caused by another disorder, headache is symptom
- Sinus headaches
- intracranial mass
- Low CSF pressure headaches
- Benign Intracranial HTN
- Chiari Malformation
- Neuralgia
Migraine symptoms
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
Migraine Triggers
- Stress/lack of sleep
- skipping meals
- dehydration
- bunch of foods including MSG
- hormonal changes (menses, birth control, pregnant)
- medications (nitroglycerin)
Migraine Drugs (treat after onset)
NSAIDs, anti-emetics, triptans, ergots
Status Migrainosus
Migraine >72h
-can require ER visit
Transformed Migraines
Migraine–>episodic headache
episodic<15d, 15
Tension Headache
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
Trigeminal Autonomic Cephalgias
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)
Cluster Headaches
- 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
Cluster Headache treatment
Abortive: O2, lidocaine, octreotide
Preventative: bunch, verapamil
Transitional: trigeminal n. block, steroids
Hemicrania
Unilateral headache, always same side/region. Time varies
- Paroxysmal
- Continua
- SUNCT
- SUNA
Paroxysmal Hemicrania
- Severe unilateral pain
- orbital/temporal
- lasts minutes, but many times/day
Continua Hemicrania
Incessant (>3mo) severe side-locked headache that only responds to indomethacin
SUNCT
Moderate-severe unilateral pain
- orbital/trigeminal distribution
- lasts seconds-minutes
- stabbing/sawtooth pattern
SUNA
- attacks last 7d-yr, remission for months. Multiple/day
- Only lasts seconds-minutes
- Autonomic involvement (
Indomethacin-responsive headaches
- Paroxysmal Hemicrania
- Cough-induced
- Ice-picking (Stabbing)
- SUNA
New Daily Persistent Headache
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
Primary Stabbing Headache
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!
Thunderclap Headache
Sudden onset severe headache
- lasts hours-days, can recurr in week
- young women with Hx migraines
- Rule out subarachnoid hemorrhage! or AVM,
Sinus Headache (2º)
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)
Medication Overuse Headache (2º)
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
Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)- 2º
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
Low CSF Pressure Headache (2º)
“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
Chiari Malformation Headache (2º)
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
Cranial Neuralgia (2º)
Neuropathic pain in distribution of CN- brief, sharp stabbing
- Trigeminal neuralgia (tic douloureux)- W>M, older, linked to MS
- Glossopharyngeal Neuralgia
- Occipital Neuralgia
Temporal Arteritis (2º headache)
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
