Headaches Flashcards
Most common type of HA:
Tension (W > M)
SNOOP 4 flags for headache:
Systemic disease Neurologic signs Onset that is sudden Onset that is over 40 Previous HA with new features Progressive Postural Precipitation by valsalva/exertion
Migraines will hit their max pain usually in:
1-2 hours
What is a defining feature of migraines vs. SAH:
Transient with ipsilateral tearing and rhinorrhea
Imaging needed for HA:
MRI without contrast
Frequencies of HA:
Infrequent: <1 d/month
Frequent: 1-14
Chronic: >15/month
Tension headache does NOT
Throb - it is a headband of pressure
TTH has at least two of the following (4):
- Bilateral head or neck pain
- steady pressing or tightening and non-throbbing pain
- Mild to moderate pain
- not aggravated by normal physical activity
Best treatment for tension
Rest
Do not want to treat a HA for more than how many days a month (risk of developing MOH)?
More than 9
Treatment for Tension headaches (4):
- Ibuprofen (600 I; 800 I)
- APAP 1000 x1
- Ketorolac injection IM
- Excedrin with caffeine (APAP)
Cannot use what in pregnancy?
NSAIDS
A menstrual migraine (starting 2-3 days) from too low estrogen does not have:
An aura
Cluster headaches are more common:
In men and at night
Cluster headaches have:
Throbbing
Two most common types of aura:
- visual
2. Sensory
What is cutaneous allodynia?
Perception of pain produced by the innocuous stimulation of normal skin
What type of headache affects young women and children?
Basilar - Vertigo + dysarthria
Retinal ocular migrants result in:
Monoocular stomata that lasts an hour that is followed by a HA
If you have someone with migrainous vertigo make sure they do not have:
Meniere’s
Migraine without aura (more common) has more than two of the following 4:
- Unilateral location
- Pulsating quality
- Moderate-serve intensity
- aggravation by routing physical activity
Food triggers are more likely to tip off a:
Migraine
Why do oral agents not work as well when someone has a migraine?
Because there is secondary gastric stasis
Options for acute treatment of a migraine:
- NSAID +/- APAP
- Triptan (inhaled)
- Ergots
You can use what medications for nausea AS MONOTHERAPY?
IV Metoclopramine or IV/IM chlorpromazine and prochlorperazine or IV ondansetron (zofran)
Do not use this for a headache!!!
Opioids
If you have more than 4 HA a month, take prophylactic treatment (2):
1st line options: Beta-blockers (propranolol) and AEDS (topiramate) - need 4-6 weeks to work
Menstrual HA treatment?
Long extended release OC and triptans
What triggers an attack in a cluster HA most common in men?
Alcohol - will be sensitive during the episode
Cluster HA happen at:
Night
What are symptoms of cluster HA?
Unilateral throbbing, corners, rhinorrhea and conjunctiva injection
What are two treatments for cluster HA?
Oxygen and triptans
*prednisone can be a bridge
SUNCT syndrome is what?
Short-lasting unilateral neualgiform HA with conjunctival injection and tearing - more common in men
If you have SUNCT, you need to do a:
MRI
SUNCT is how short:
30-120 seconds
What is chronic paroxysmal hemicranial?
More common in women, CONTINUOUS head pain
Treatment for CPH
Indomethacin
What is a sign of pseudotumor cerebri?
Papilledema
Diagnosis for Pseudoturmor cerebri?
20-30 mL of CSF - will reduce pressure
Treatment for pseudo tumor cerebri:
Acetazolimide - next best is topiramte
What is the difference between hemicranial continua and CPH?
HEMICRANIA continua never really goes away
