Headaches

Question 1

Tension headaches

Answer 1

Produce little disability
can last 30 minutes to several hours
bilateral
steady and non pulsatile
mild to moderate intensity
may prohibit but do not inhibit activity

Question 2

tension headaches

Answer 2

non N/V should be present
photophobia or phonophobia but not both
No evidence that accounts for underlying HA

Question 3

Common Migraine

Answer 3

Migraine with no aura
last 4-72 hours
Must have two of the following:
unilateral head pain
throbbing
moderate to severe
pain aggravated by routine activity

Question 4

common migraine

Answer 4

Must also have 1 of these:
n/v
phtophobia or phonophobia
Aura's are in 15% of migrain attacks
Generally proceded ha by less than 1 hour

Question 5

Phases of Migraines

Answer 5

Prodrome is far more common than aura
involve changes in mood, or energy level, alteration in sensory processing, muscle changes, yawning
Probably redirect the milieu of the CNS

Question 6

phases of Migraine

Answer 6

chocolate was considered a trigger
but now know craving carbohydrates is a prodrome
Prodromes are important markers for timing of treatment
Auras can also be part of the pre-headache phase

Question 7

phases of migraines

Answer 7

Headache phase:
begins mild ad progresses to severe
unilateral, but can be bilateral
4-72 hours
In children and adolescents duration is less than 4 hours

Question 8

After migraines

Answer 8

symptoms may last 1 to 2 days

Question 9

4 Diagnostic questions

Answer 9

how does it interfere with your life
any change in the pattern
how do you experience the ha’s
how often do you use medications

Question 10

Cluster HAs

Answer 10

Other:
cerebral aneurysm
sub-arachnoid hemorrhage
ICP

Question 11

Analgesic rebound

Answer 11

Suspect with c/o daily ha

Inquire about frequency of use

Question 12

Traction/inflammation

Answer 12

Diseases of the cranium bones

referred pain from sinuses, teeth, tmj, ears and back

Question 13

Meningeal irritation

Answer 13

will have a rise in temperature

Question 14

Temporal arteritis

Answer 14

Differential Dx”
elevated sedation rate
tender to palpation

Question 15

Manage migraines

Answer 15

Abortive therpay
use at firt indication of headache
Triptans: Imitrex
seperate dosages by 2 hours
May augment with Reglan if n/v is severe
NSAIDS @ higher doses

Question 16

manage migraines

Answer 16

AVOID triggers
Relaxation techniques
Accupressure- not for pregnant women
regular exercise
adequate sleep
good nutrition
narcotics-last ditch effort

Question 17

manage migraines

Answer 17

combination analgesics
Ergots-
Corticosteroids
Pregnant women need to avoid triggers, use non pharm measures
may take tylenol

Question 18

Preventive therapy

Answer 18

not for all
If more than 4 per month
if severe
if do not respond to medication

Question 19

Consider other condition

Answer 19

HTN

epilepsy

Question 20

Preventative drugs include

Answer 20

beta blockers
Ca channel blockers
anticonvulsants
trycyclic antidepressents
SSRIs

Question 21

Migraine F/U

Answer 21

RTC every 2-4 weeks x3 months until responding to medication

Question 22

Red flags for referral

Answer 22

Can't control HAs
new and worsening
effect quality of life
rebound HA
Neuro symptoms

Question 23

Meningitis

Answer 23

infection results in inflammation of the meningies
most often caused by a bacterial agent
high fever, HA, photophobia,
nugal rigidity

Question 24

Meningitis

Answer 24

get Hx
travel?
food consumption?
sexual practices?
drug use?

Question 25

Meningitis

Answer 25

``` physical temp, pulse, rr all elevated Brudinskis sign kernigs sign-can't fully extend legs (these will not exclude) ```

Question 26

meningitis

Answer 26

``` altered level of consciousness confusion stupor assess cranial nerves diplopia, deafness, facial weakness, pupillary abnormalities ```

Question 27

meningitis

Answer 27

CBC elevated WBC serum glucose LP will be done after referral

Question 28

Bells palsy

Answer 28

``` unilateral paralysis of face often precedes by viral infection acute onset with max paralysis at 48-72 hours may have altered taste and increased sensitivity to sound hx of recent infections chronic diseases? Insect bites? Pregnancy?-occurs more frequently ```

Question 29

Bells palsy -physical exam

Answer 29

head and neck cranial nerve assessment corneal light reflex may be decreased eyeball may roll upward when close eyelid

Question 30

bells palsy

Answer 30

usually no tests indicated | exclude Lyme disease and infection with CDC diff

Question 31

Manage Bells palsy

Answer 31

``` Prevent eye injury lube for nightime sleep-methylcellulose protective eyewear eye cup at bedtime facial massage Prednisone: 60-80 mg /day for 1 week taper second week if severe, add valacyclovir-1000 mg 3x/day If pregnant, consult OB ```

Question 32

Dizziness/Vertigo | Vestibular neuronitis-Cranial nerve VIII

Answer 32

Acute labyrinthitis-involves cochlea and may cause hearing loss-caused by a virus infection in the labyrinth

Question 33

vestibular neuronitis

Answer 33

often occurs after URI followed by vertigo Symptoms resolve in 3-6 weeks have client describe dizziness medical problems Do they happen with activity or movement? describe onset and hearing involvement

Question 34

ask?- for Vestibular neuronitis

Answer 34

ask about head trauma Do vision exam Weber test-lateralization to unaffected with sensorineural hearing loss See handout

Question 35

Vestibular neuronitis

Answer 35

``` lie down in darkened room antibiotics if associated with bacterial infection Methyprednisone once daily for 22days 100 mg day 1 to 3 80 mg 4-6 60 mg 7-9 40 mg 10-1220 mg 13-15 10mg 16-18 none on day 19-21 and then 10 mg on day 20 and 22 ```

Question 36

vestibular neuronitis

Answer 36

no antiemetics after 3 days | 3-6 weeks symptoms resolve spontaneously

Question 37

Menieres

Answer 37

bed rest during an attack refer to otolaryngologist for testing and management may need to decrease NA, caffeine, alcohol and tobacco Antivert and antiemetics with sever symptoms diuretics may reduce severity

Question 38

Menieres

Answer 38

``` 2 episodes last at least 20 minutes hearing loss, tinnitus, aural fullness Vertigo UNRELATED to position change Hearing loss is reversible initially, then can become permanent. ```

Question 39

Benign positional paroxysmal vertigo- | Assiociated with movement

Answer 39

position changes cause an abrupt onset NO tinnitus or hearing loss, but may have n/v Common in the elderly

Question 40

BPPV

Answer 40

which moves within the semicircular canal most common type | caused by free floating particle matter with certain head movements

Question 41

BPPV

Answer 41

Characteristic is the nystagmus rolling over laying down

Question 42

BPPV

Answer 42

if the nystagmus is vertical or torsional in nature and lasts 30 seconds, it is consistent with a posterior semicircular canal varant nystagmus peripheral causes produce 3-10 second delay in onset, lessens with repetition and is ina fixed direction If it is central, it starts immediately, does not fatique with repitition and may be in any direction

Question 43

BPPV

Answer 43

Can use Epleys maneuver | Meds probably wont help