Headaches Flashcards
What are causes of HAs in pregnancy?
1) hormonal changes
2) increase in blood volume
3) tension
4) postural changes
5) muscle strain
6) preeclampsia (3rd tri)
List the types of primary HAs
1) migraines
2) tension
3) cluster
4) PP
Describe the pathophysiology of migraines
neuro dysfunction –> decreased cortical blood flow –> vascular and meningeal receptor activation –> trigeminal sensory neurons stimulated
List the types of migraines
1) w/out aura: unilateral, throbbing, N/V, photophobia
2) w/ aura: reversible in 5-60mins; can occur w/out HA
3) chronic: migraine 15 days/mo for >3mo
What is the course of migraines in pregnancy?
decrease in 2nd and 3rd tris
*increased risk of preeclampsia
How can migraines be treated pharmacologically?
1) acetaminophen as soon as sx start
2) acetaminophen + metoclopramide (Reglan) or compazine 10mg
3) acetaminophen + codeine 30mg
4) acetaminophen + caffeine
5) Fioricet = butalbital + acetaminophen + caffeine
6) antiemetics (e.g. Compazine)
7) triptans = a last resort
8) opioids = ultra last resort; can worsen N/V/C
Which meds can cause rebound migraines?
1) acetaminophen + codeine: if using >9days/mo –> neuro consult; neonatal abstinence syndrome
2) Fioricet: no >4-5days/mo
How should severe migraines be treated?
1) IV hydration
2) IV antiemetics
3) IV mag
4) Benadryl
5) Compazine
6) +/- short-term narcotic or Botox
What is the max dose of acetaminophen?
4g per day
What should meds should be avoided in tx of migraines?
ergots (vasoconstriction of uterine vessels –> abortion) + NSAIDs
How should pts be educated w/ Fioricet use?
contains acetaminophen, so do not take more on top of that!
What is the most common type of HA in pregnancy?
tension-type
List the tension-type HA categories
1) infrequent episodic
2) frequent episodic
3) chronic
infrequent episodic (tension-type)
- 10-12/year or <1/mo
- last 30min - 7 days
- 2+ characteristics: B/L, non-pulsating, mild/moderate, not worse w/ activity
- N/V not attributed to another disorder
- photophobia or phonophobia
frequent episodic (tension-type)
- ≥10 episodes/mo on 1-14 days/mo for at least 3mo
- last 30 mins - 7 days
- 2+ characteristics: B/L, non-pulsating, mild/moderate, not worse w/ activity
- N/V not attributed to another disorder
- photophobia or phonophobia
chronic
tension-type
- ≥15days/mo for at least 3 mo
- last 30 mins - 7 days; lasts hours or is continuous
- 2+ characteristics: B/L, non-pulsating, mild/moderate, not worse w/ activity
- N/V not attributed to another disorder
- photophobia, phonophobia, mild nausea
What is pharmacological tx for tension HAs?
1) acetaminophen
2) acetaminophen 500mg + caffeine 100mg
3) acetaminophen + codeine 30mg
4) Fioricet
What are non-pharm tx for migraines and tension HAs?
1) regular, adequate sleep
2) relaxation: meditation, breathing, progressive relaxation
3) CBT
4) physical therapy: massage, TENS, chiropractics heat/cold
5) biofeedback
6) diet (dec tyramines, alcohol, chocolate)
7) HA diary - avoid triggers
8) magnesium 400mg/day prophylaxis
cluster HA presentation
- unilateral
- severe
- explosive
- felt in face and eyes
- 15min - 3h
- watery eyes, stuffy nose, sweating
- ANS dysfunction, agitation
*pre-existing cluster HAs should be referred to neuro
What is pharmacological management of cluster HAs?
1) O2 can eradicate
2) sumatriptan
3) topical lidocaine (gel) inside nostril on affected side of head
3) preventative tx
- verapamil
- glucocorticoids
*does not respond to non-pharm tx
What do PP HAs occur?
in first week, very common
What are PP HA differentials?
- preeclampsia
- anesthesia complications
- CVT
- PP angiopathy
List the reasons for secondary headaches
1) idiopathic intracranial HTN (IIH)
2) central vein thrombosis
3) subarachnoid hemorrhage
4) reversible cerebral vasoconstriction syndrome
….infection, substance abuse, withdrawal, trauma, tumor, encephalitis, psych disorder
idiopathic intracranial HTN
patho
unknown
elevated prolactin found in CSF
