Headaches (chronic) Flashcards
important aspect when dx headaches
For any particular dx given, all listed criteria must be furfulled
Causitive factors of headaches (9)
- Fatigue/slee[
- Stress
- Chronobiological
- climatological
- chemical/diet
- hormonal
- cervical
- ocular
- TMJ
What are the questionairs u can use to assess headache
- Migrane disability assessment
- Headache disability index
- Beck depression index
- Headache symptom log
3 HAs a week vs 4 HAs a week risks/outcomes
3- headache associated w disability
> 4- depression and anxiety are sig greater in these pts
What are the chronic headaches (6)
- Tension type
- Migraine
- Migraine varients
- Cluster
- Cervicogenic
- Rebound
4 classifications of tension type ha
- Infrequent episodic tension type
- frequent episodic tension type
- Chronic tension type
- Probable tension-type
overall look of tension type Ha
front and back of head
starting in the morning and then worsening thru the day
Chronic >15days
when do people usually get their first tension type HA
40%- b4 20
40% between 20-40
18% between 40-50
What precipitating factors may trigger a tension HA
- stress
- change in sleep
- meds
- skipping meals
- physical exertion
- certain foods
- female hormonal changes
What triggers a TTH
may have multiple triggers that have an additive effect of lowering the thresholdd of ha activation
Infrequent episodic TTH criteria (4)
- at least 10 episodes occurring <1d/m (<12x a year)
- lasts 30mins to 7 days
- Headache has <2 of these conditions (bilateral, pressing, mild/mod, not aggravating PA)
- Both no nausea/vomiting, no more than 1 of photophobia/phonophobia
Episodic tension type HA criteria
Ha >1 day/m and < 15m for at least 3m
Ha lasting 30mins to 7days
At least 2 of following (Pressing, mild/mod intensity, bilateral, no aggravation w PA_)
No nausea/vommiting, one of photophobia/phonophobia
Chronic TTH crieria
A. HA on >15d/m for >3m
B. lasts hours
C. Two of (bilateral loc, pressing, mild/mod, not aggravated by PA)
D. Not >1 photophobia, phonopobia
what % of pop goes thru chronic tension type HA
3%
increases w age
Theories for tension-vascular spectrum ha
- Central mechanism
- mm tenderness
- chronic tension type headache (central opiod function)
- NT def
Pts w TTHA are more susceptible to what
Perminatly and universillar more sensitive to pain stim
Rebound HA stats
40-70% of pts seeking care at headache or pain clinical clinics are thought to be suffering from this
possible presentation of rebound headache hx
Frequent use (2x w) of over the counter or prescription meds
Rebound ha symptoms
(similar to tension)
- Daily or nearly daily HA
- Bilateral Head pain
- pressing/tightening quality
- t/t neck and shoulder mm
Possible HA red flags
- First HA or worst
- Worsening pattern
- Focal neuro signs
- fever w HA
- Change in mental status/personality
- Rapid onset
- progression
Possible prodrome fx of migraine
- depression
- irratability
- restlessness
- anorexia
- may be associated w aura (10-20% of occurrences)
migraine w aura criteria
Atleat 2 of following
- Homonymous visual symptoms or unilateral sensory symptoms
- At least one aura develops gradually over >5mins
- Each symptom last >5m + <60 mins
Migraine aura vs TIA
Migrane
- visual symtoms
- GRADUAL ONSET
- LASTS 60 MINS
- HA FOLLOWS 50% of Time
TIA
- visual LOSS
- ABRUPT
- Duration <15mins
- HA is uncommon after
migraine w/o aura criteria
A. Atleast 5 attacks of the following:
B. HA lasts 4-72hrs, <15 days per month
C. HA has at least 2 of following (Unilateral, pulsating, mod to severe, aggravated by PA)
D. During HA at least one of (nausea/vom, photo/phonophobia)
