Headaches Flashcards
What are two important questions in neurology?
How long have you had this? Sudden or gradual?
Acute
now (1-2 days)
Subacute
Recent (2 days-3 weeks)
Chronic
Months to years
Remote
A long time ago
How to characterize a migraine and the timeline?
Most common HA.
Prodrome> Aura> HA> Postdrome.
“Miserable”.
Sxs of migraines
Typically lateralized, bounding, lasts all day. +N/V.
+/- Aura
What is an atypical migraine?
Migraine with different characteristics. Typically without aura. “Weird”
What gene is thought to be exaggerated in people with migraines?
CGRP (people with migraines have increased CGRP)
Calcitonin gene
Related to protein signalling- thought to be exaggeratedin migraines. Calcitonin is a neuropeptide that signals pain in the trigeminal nerve (CN V= sensory nerve of face)…Calcitonin peptide is increased during migraine and decreases when migraines stop.
What is a recent new tx for migraine?
Block calcitonin gene related to peptide receptors»_space; meds block calcitoin GRP receptors
What are abortive meds for migraine?
=stops HA’s.
OTC= ibuprofen (hard on kidnesy and stomach), Tylenol (tough on liver).
Serotonin R ant’s: Triptans= Vasoconstictors (avoid in MI/Stroke. Causes paresthesia). Ergot (vasoconstrictor, some nausea, often given with antiemetics).
Butalbitals: Pain killer (ex.Fioricet)= works like ETOH/addictive, sedation (great for ppl with bleeding issues)
What is good for treating migraines in ER situations?
1) Ketorolac/Toradol = ibuprofen type (hard on kidneys and stomach).
2) Benadryl= antihistamine (puts ppl to sleep).
3) Compazine= nausea medications, dopamine receptor antagonist (like haldol, can cause tardive diskinesias)
Why should you not give migraine meds (triptans/ergots) to patients with a hx of stroke or MI?
They are vasoconstrictors and cause blood clots
Medication overuse headaches
Using too many migraine meds can cause migraines! If you use any meds more than twice per week, it can trigger HA’s (tylenol, ibuprofen). Opiates give you rebound HA’s (esp. Morphine)!
Tx: try medrol dosepack and taper off medication.
When patients call the office with a headache, what do you give them?
Toradol/ketorolac and medrol dosepack are great for pts that call into the office the HA’s. Troadol IM 30mg to 60mg (bad on kidnesy and stomach), Medrol dosepak oral = several days of oral steroids (can cause anxiety or insomnia).
Treatment approach to migraines
Neck pain? Yes!»_space; Muscles relaxers (tizanidine, flexeril), acupuncture, chiropractic manipulations.
Trouble sleeping?»_space;Amitriptyline/nortriptyline (TCA, antidepressant),
DRY MOUTH. Weight loss?»_space; Topiramate/topamax (anit-seizure med) KIDNEY STONES, WORD FINDING (dopamaz)
Natural supplements
Can help treat young pts or pt’s who don’t like medications.
Magnesium (oxide=pill, citrate = solution) = helps with aura and preventing migraines.
Coenzyme q10= good for migraine prevention, especially helpful for statin- induced HA’s.
Riboflavin (B2) or B-complex= good for ppl who may have an unbalanced diet.
Vitamin D= Inverse relation between Vit D and migraines. Vit D can help with reducing migraines.
What is a tension headache?
Band like, mild, short and triggered by stress
What is a cluster HA?
Severe, unilatral pain, lacimation, nasal congestion, sharp, behind the eye, restless, short duration ~4mins-2hrs, o2 helps. Most common in men.
*very RARE
Does HTN cause anterior of posterior HAs?
posterior
What is idiopathic intracranial HTN (pseudotumor cerebri)?
Basically an increase in pressure around the brain causing HA, blurred VA and tinnitus.
Can lead to papilledema
Generally in obese pts.
Pulsatile tinnitus (can hear own heartbeat, HA’s, blurred vision. Dx: if acute get LP (if opening prssure is over 250mm H2O (25cm). Tx: draining fluid until pressrue is back to normal. *LP can cause HA’s. Also, treat chronicly with diet (need 5% weight loss) and acetazolamide (diamox..s/e= numbness in extremities, or kidney stones).
How do you treat idiopathic intracranial HTN
LP- drain fluid until pressure is back to normal
**Can cause HA though
Concussion
Sx: HA’s , dizziness, insomnia, mood swings.
Tx: medrol dosepak and amitryptline (go low, start slow)
