Headaches Flashcards
Primary headaches
migraine
tension
cluster
secondary headaches
caused by underlying organic disease
cervicogenic headaches
secondary although some classify as primary
abnormal findings with headaches warrant what?
neuroimaging to rule out intracranial pathology
what is the preferred method to rule out hemorrhage?
CT
MRI is necessary for imaging what?
posterior fossa
what are CSF analyses for?
hemorrhage
infection
tumor
CSF disorders
headache onset after 50 years is?
a red flag
ddx for headaches beginning after 50 years
temporal arteritis
mass lesion
possible work ups for headaches beginning after 50
ESR/CRP, neural imaging
ddx for sudden onset headache
subarachnoid hemorrhage
mass lesion
vascular malformation
possible workup for sudden onset headache
neuroimaging
lumbar puncture if neuroimaging is negative
ddx for increased frequency and severity of headache
mass lesion
subdural hematoma
medication overuse
possible workup for increasing frequency and severity of headache
neuroimaging
drug screening
red flags considering headaches
>50 years sudden onset increase in frequency and severity HIV/cancer systemic illness (fever, stiff neck, rash) focal neurological S&S papilledema subsequent to head trauma
ddx for headache from HIV/cancer
meningitis
abcess
metastasis
possible workup for headache from HIV/cancer?
neuroimaging
lumbar puncture if neuroimaging is negative
ddx for headaches from systemic illness
meningitis encephalitis lyme disease systemic infection collagen vascular disease
possible workup for headaches from systemic illness
neuroimaging
lumbar puncture
serology
ddx for focal neurological S&S
mass lesion
vascular malformation
stroke
collagen vascular disease
possible workup for headaches from focal neurological S&S
neuroimaging
collagen vascular evaluation
ddx for a headache with papilledema
mass lesion
meningitis
possible workup for headache with papilledema
neuroimaging
lumbar puncture
ddx for headache from subsequent trauma
intracranial hemorrhage
subdural/epidural hematoma
posttraumatic headache
possible workups for headaches from subsequent trauma
neuroimaging of the brain, skull and possibly cervical spine
migrain pain location
unilateral
tension headache pain location
band like and bilateral
cluster headache location
strictly unilateral
temproal arteritis headache location
distribution of temporal artery
trigeminal neuralgia pain location
distribution of trigeminal nerve
acute glaucoma pain location
eye pain
what is one of the most common cause of headaches?
whiplash
4 primary headache patterns
migrain
tension type
cluster headache
cervicogenic
when must acute headache be evaluated?
if associated with neurologic S&S
describe a migraine
associated with nausea, vomiting, or sleepliness and separated by pain free intervals
what is a chronic progressive headache? What may be suspected?
severity and frequency increase over time
structural disorder of CNS
what is a chronic nonprogressive headache?
most typical type, usually related to stress
most patients presenting to physician’s office for evaluation of headache have what?
either a tension headache or migraine
S&S of a migraine
nausea photophobia phonophobia exacerbation by physical activity aura
intracranial organic pathologies are from what?
infection intracranial mass lesion hemorrhage hypertensive parenchymal hemorrhage, subdural hematoma ischemic conditions traumatic brain injury
other organic syndromes
cluster headache cranial bone pain scalp pain vascular involvement eye pain ear pain acute sinusitis dental pain facial nerve pain neck pain acute febrile illness metabolic disorders
red flags for headaches
sudden, severe headache new headache, older patient headache due to head trauma associated residual neurologic S&S cognitive changes vomiting w/o nausea persistent or progressive headache nuchal rigidity with or without fever suspicion of drug or alcohol dependance headache associated w' 15-mm Hg persistent/severe headache in child
headaches associated with exertion may mean
underlying tumor or vascular weakness
when do you do a CT/MRI for post traumatic headaches?
signs of neurological dysfunction and loss of consciousness
most primary headaches occur when?
at an early age and are recurring
when should a new headache be a concern?
if they are middle aged or older complaining of a new headache
older patients with a temporal headache need to be considered to have..
temporal arteritis
headaches that are constant and more severe without reprieve likely indicate
intracranial process and should necessitate a referral for evaluation
how to manage a headache without red flags
modify patient behavior (sleep, diet, exercise)
manage with CMT
supplements or herbal alternates
nonpharmacological treatments,
if chiro is unsuccessful (acupuncture/biofeedback)
refer for medical management if still unsuccessful
