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X Clin Med III Exam 3 > Headaches > Flashcards

Headaches Flashcards

1
Q

Most common benign headaches

A

Migraine, cluster, tension

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2
Q

Types of headache

A

Vascular (migraine, cluster)
Muscle contraction (tension)
Traction (organic diseases of head like intracranial mass)
Inflammatory (meningitis, giant cell arteritis etc)

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3
Q

Types of primary HAs

A

Migraine, cluster, tension type

Chronic daily HA, primary stabbing, primary exertional, hypnic (“alarm-clock”)

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4
Q

Most common diagnosis given

A

Migraine

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5
Q

Most debilitating HA

A

Cluster

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6
Q

Most frequent HA

A

Tension type

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7
Q

Most important factor in establishing diagnosis of HA

A

History

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8
Q

Important history questions for HAs

A 
Frequency, duration, intensity, location
Quality
Time and setting of onset
Aggravating/ alleviating factors
Age of onset
Associated sxs (nausea, photophobia, phonophobia, focal neuro presentation)
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9
Q

Triggers of HAs

A 
Diet (caffeine, alcohol, chocolate)
Hormones (menses, HRT)
Sensory stimuli (light, odor, sound)
Stress 
Environment
Change in habits
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10
Q

Pneumonic for migraines

A 
Pulsatile
hOurs 4-72 hrs
Unilateral
Nausea
Debilitating
ing
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11
Q

Associated sxs of migraines

A

Photophobia
Phonophobia
N/v
Movement worsens sxs

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12
Q

Types of migraines

A

Migraine without aura (common)- more frequent type

Migraine with aura (classic/complex)

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13
Q

Characteristics of migraine without aura

A

HA occurs without warning
Unilateral pain 4-72 hrs (throbbing, pulsatile)
Nausea, confusion, blurred vision, mood changes, sensitivity to light/sound

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14
Q

4 phases of migraine with aura

A

Prodrome
Aura
Headache
Postdrome

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15
Q

When does the aura occur?

A

Classically 10-60 min prior to HA (may be during HA or no HA occurs)
Last less than 60 min!! (if longer than that then be worried about something else)

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16
Q

Prodrome of migraine

A

24-48 hrs prior to HA

Food cravings, mood change, uncontrollable yawning, fluid retention, constipation, neck stiffness

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17
Q

Aura associated with a migraine

A

May occur prior to or concurrent with HA
Positive sx: visual, auditory, sensory, motor
Negative sx: loss of function, vision, hearing, sensation, motor

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18
Q

HA in migraine with aura

A

Builds gradually in intensity
Commonly unilateral pulsatile or throbbing pain
Same associated sxs

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19
Q

Postdrome of migraine with aura

A

Confused or exhausted

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20
Q

Types of migraine auras

A

Visual (area of visual loss, bright spot, lights, shapes, heat waves)
Sensory (tingling, weakness)
Language

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21
Q

What is cutaneous allodynia?

A

Associated with migraine
Abnormal pain response from things like combing hair, shaving, wearing glasses, contact lens, earrings, tight fitting clothes

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22
Q

Imaging for migraine

A

No imaging needed if have classic hx and no change in sxs

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23
Q

Scenarios that might warrant imaging with a migraine

A 
Worst HA of my life
Changes in HA presentation
New or unexplained neurologic sxs
HA not responding to tx
New onset after 50 or in pts with CA or HIV
*CT recommended over MRI
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24
Q

How to differentiate between aura and TIA

A

Aura: gradual onset, duration no longer than an hour, types may overlap and ebb and flow
TIA: rapid onset, maximal intensity within few minutes lasting up to 24 hrs, multiple deficits occur simultaneously

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25
Tx of acute migraine
Decrease triggers, dark quiet environment, cool cloth Fluids, caffeine early on Meds depending on severity
26
First line meds for abortive therapy of mild to moderate migraine
Oral NSAIDs, acetaminophen or OTC combo | n/v add antiemetic
27
First line meds for abortive therapy of moderate to severe migraine
Triptans and Ergots (oral or combo with NSAID--subq if n/v etc)
28
Side effects of triptans
Tripton sensation: injection site rxn, chest pressure or heaviness, flushing, weakness, drowsiness, dizziness, malaise, feeling of warmth, paresthesia Resolves in 30 min tho
29
Contraindications of triptans and ergotamine
It is a vasoconstrictor so uncontrolled HTN, pregnancy or hx of MI, cerebrovascular disease, peripheral vascular disease
30
Lifestyle changes to prevent migraines
Appropriate amt of sleep Routine meal schedule Regular exercise Avoidance of triggers
31
Meds for preventative migraine tx
``` BB: propranolol Amitriptyline Anticonvulsants: valproate and topiramate Others (CRGP antagonists etc) *start low and go slow ```
32
Characteristics of tension type HAs
Bilateral pressure, band-like Non-throbbing, mild to moderate in intensity Lasts 30 min to 7 days Associated sx: anorexia, head/neck pain with muscle tenderness, bruxism (grinding teeth)
33
What will not be seen with a tension HA?
Phonophobia, photophobia, aura or n/v
34
Triggers for tension HAs
Stress, jaw clenching, missed meals, depression, too little sleep, head/neck strain
35
Episodic tension headaches
Infrequent: <12 days/ yr and lasting <1 day/mo Frequent: 1-14 days/mo lasting 30 min to several days Not disabling
36
Chronic tension headaches
>15 days/mo, lasts hours to days, may be unremitting
37
Imaging for tension headache?
Not needed unless unexplained abnormal neuro findings or atypical presentation
38
Management of tension headaches
Underlying cause Acute: NSAIDs, acetaminophen, aspirin, combo (high initial dose) Hot shower or heat to back of neck
39
Management for chronic tension HA
Most often have stress, anxiety, depression | Antidepressants, biofeedback, relaxation training, meds etc
40
What should be avoided with chronic tension HA?
Opioids or barbiturates b/c high potential for med overuse HA
41
Characteristics of cluster HAs
Males! Brief: 15-180 min Sharp boring unilateral periorbital HA with autonomic sxs!! (trigeminal autonomic cephalgias) Similar time of day/night x several wks with period of remission (clusters 6-12 wks and remission can be up to 12 mos)
42
Chronic cluster HA
Clusters lasting >1 yr or remission <1 mo
43
Presentation of cluster HA
Restless and pacing Severe orbital, supraorbital or temporal pain Autonomic sxs May have an soociated sx like migraine aura
44
What autonomic sxs are seen in cluster HAs?
Conjunctival infection, lacrimation, eyelid edema, nasal congestion, rhinorrhea, facial sweating, miosis, ptosis Ipsilateral to the pain!!! Parasympathetic hyperactivity and sympathetic impairment
45
Triggers of cluster HA
Alcohol and smoking (can not have!), smells stress
46
How to diagnose cluster HA
MRI with and without contrast or plain CT with initial dx (looking for a secondary cause)
47
#1 tx for cluster HA
O2 in nonrebreathing facemask 100% 02 at >12L/min Sitting upright Continue for 15 min even if attack ends before that
48
When to not use O2 with cluster HA
Severe COPD (risk of hypercapnia and CO2 narcosis)
49
Other tx for cluster HA
Triptian, intranasal lidocaine, ergots
50
DOC to prevent cluster HA
Verapamil (at onset of cluster episode)
51
Chronic daily HA characteristics
>15 days/mo during 3+ mos | Moderate pain on sides or top of head
52
Types of chronic daily HA
Chronic migraine Chronic tension type Hemicrania continua New daily persistent HA
53
What is hemicrania continua?
Continuous, fluctuating pain on same side of face/head lasting minutes to days Associated sxs: tearing, irritated eyes, rhinorrhea, swollen eyelids
54
Tx for hemicrania continua
Indomethacin
55
Presentation of new daily persistent HA
Abrupt onset and does not remit Ranges from mild to severe (throbbing tightening on both sides of head) Light/sound sensitivity May be due to infection, meds, trauma etc Tx: muscle relaxants, antidepressants, anticonvulsants
56
Characteristics of primary stabbing HA
Ice pick or jabs and jolts HA Pain is intense and strikes without warning (1-10 sec) Usually around eye but may be near trigeminal nerve Often associated with other sxs Tx: indomethacin or abortive meds if multiple episodes occur
57
Characteristics of primary exertional HA
Trigger: coughing, sneezing, intense activity Last minutes to days Associated sx: n/v
58
Imaging for primary exertional HA
MRI/MRA to r/o vascular abnormalities (risk increases >40 YO and focal neuro sx)
59
Tx for primary exertional HA
Warm up exercises, NSAIDs, indomethacin
60
Characteristics of hypnic HA
``` Later in life (>50 YO) Develops during sleep and awakens ppl at night >10 episodes/mo lasting 15 min-3 hrs Mild-mod throbbing at both sides of head N/v, sensitivity to light/sound ```
61
Imaging for hypnic HA
For new presentation (MRI preferred to CT)
62
Tx for hypnic HA
Caffeine at night, indomethacin, lithium
63
Alerts that indicate referral with secondary HA!!!!
``` First HA in pt over 50 Sudden intense HA without previous hx of HAs Nuchal rigidity, Kernig or Brudzinski Diplopia Papilledema or retinal hemorrhage Persistent or new neuro signs (>60 min) Fever Excessive BP elevation Hx of head trauma, malignancy, coagulopathy Change in previous HA presentation ```
64
Pneumonic for when to evaluate for secondary HA
``` Systemic sx or illness (HIV, CA, infection, meningitis) Neurologic (mass, lesion, stroke, SUD) Onset sudden Older (new onset>50 YO) Previous HA hx (1st HA or change in HAs) ```
65
Sxs of secondary HA related to structural abnormalities
Chiari malformation, syringomyelia Septum deviation causing obstruction TMJ dysfunction
66
Sxs of secondary HA related to cranial neuralgias
``` Trigeminal neuralgia (stabbing, shock like pain) Occipital neuralgia ```
67
Sxs of secondary HA related to CSF pressure
Idiopathic intracranial HTN (pseudotumor cerebri-sx increase with cough, exertion, straining, position) Post lumbar puncture HA (leak)
68
Sxs of secondary HA related to brain tumors
Steady worsening HA and neuro sxs | Night time awakenings
69
Sxs of secondary HA related to SAH (vascular)
Abrupt severe HA (LOC, nuchal rigidity, first and worst HA) See hemorrhage on CT
70
Sxs of secondary HA related to CVA (vascular)
Unilateral HA on affected side (hemorrhagic or ischemic)
71
Sxs of secondary HA related to temporal arteritis (vascular)
Age >50 Throbbing temporal pain, tenderness with palpation Elevated ESR and biopsy
72
Sxs of secondary HA related to head trauma
Post concussion syndrome: delayed onset of dizziness, tinnitus, visual changes Subdural hematoma
73
What precedes medication overuse HA?
Usually episodic HA disorder
74
Medications with risk of MOH
High: opioids, barbs, aspirin Medium: triptans Low: NSAIDs
75
When to refer?
``` Pt asks for referral Provider has low comfort level with dx Diagnosis is questionable Pt not respond to tx Condition worsens or changes Unable to treat as outpatient ```

X Clin Med III Exam 3 (7 decks)

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