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cd 3303 > Headaches (chronic) > Flashcards

Headaches (chronic) Flashcards

1
Q

important aspect when dx headaches

A

For any particular dx given, all listed criteria must be furfulled

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2
Q

Causitive factors of headaches (9)

A
  • Fatigue/slee[
  • Stress
  • Chronobiological
  • climatological
  • chemical/diet
  • hormonal
  • cervical
  • ocular
  • TMJ
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3
Q

What are the questionairs u can use to assess headache

A
  1. Migrane disability assessment
  2. Headache disability index
  3. Beck depression index
  4. Headache symptom log
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4
Q

3 HAs a week vs 4 HAs a week risks/outcomes

A

3- headache associated w disability

> 4- depression and anxiety are sig greater in these pts

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5
Q

What are the chronic headaches (6)

A
  1. Tension type
  2. Migraine
  3. Migraine varients
  4. Cluster
  5. Cervicogenic
  6. Rebound
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6
Q

4 classifications of tension type ha

A
  1. Infrequent episodic tension type
  2. frequent episodic tension type
  3. Chronic tension type
  4. Probable tension-type
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7
Q

overall look of tension type Ha

A

front and back of head
starting in the morning and then worsening thru the day
Chronic >15days

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8
Q

when do people usually get their first tension type HA

A

40%- b4 20
40% between 20-40
18% between 40-50

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9
Q

What precipitating factors may trigger a tension HA

A
  • stress
  • change in sleep
  • meds
  • skipping meals
  • physical exertion
  • certain foods
  • female hormonal changes
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10
Q

What triggers a TTH

A

may have multiple triggers that have an additive effect of lowering the thresholdd of ha activation

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11
Q

Infrequent episodic TTH criteria (4)

A
  1. at least 10 episodes occurring <1d/m (<12x a year)
  2. lasts 30mins to 7 days
  3. Headache has <2 of these conditions (bilateral, pressing, mild/mod, not aggravating PA)
  4. Both no nausea/vomiting, no more than 1 of photophobia/phonophobia
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12
Q

Episodic tension type HA criteria

A

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

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13
Q

Chronic TTH crieria

A

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

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14
Q

what % of pop goes thru chronic tension type HA

A

3%

increases w age

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15
Q

Theories for tension-vascular spectrum ha

A
  • Central mechanism
  • mm tenderness
  • chronic tension type headache (central opiod function)
  • NT def
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16
Q

Pts w TTHA are more susceptible to what

A

Perminatly and universillar more sensitive to pain stim

17
Q

Rebound HA stats

A

40-70% of pts seeking care at headache or pain clinical clinics are thought to be suffering from this

18
Q

possible presentation of rebound headache hx

A

Frequent use (2x w) of over the counter or prescription meds

19
Q

Rebound ha symptoms

A

(similar to tension)

  • Daily or nearly daily HA
  • Bilateral Head pain
  • pressing/tightening quality
  • t/t neck and shoulder mm
20
Q

Possible HA red flags

A
  • First HA or worst
  • Worsening pattern
  • Focal neuro signs
  • fever w HA
  • Change in mental status/personality
  • Rapid onset
  • progression
21
Q

Possible prodrome fx of migraine

A
  • depression
  • irratability
  • restlessness
  • anorexia
  • may be associated w aura (10-20% of occurrences)
22
Q

migraine w aura criteria

A

Atleat 2 of following

  1. Homonymous visual symptoms or unilateral sensory symptoms
  2. At least one aura develops gradually over >5mins
  3. Each symptom last >5m + <60 mins
23
Q

Migraine aura vs TIA

A

Migrane

  • visual symtoms
  • GRADUAL ONSET
  • LASTS 60 MINS
  • HA FOLLOWS 50% of Time

TIA

  • visual LOSS
  • ABRUPT
  • Duration <15mins
  • HA is uncommon after
24
Q

migraine w/o aura criteria

A

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)

25
Q

What is a probable migraine w or w/o aura criteria

A

Furfils all but one criteria associated w each

26
Q

series of triggers for migraine

A

(cascade)

  • CN inflammation
  • Substane P
  • Serotonin changes
  • Vasocontriction/dialation
  • HA
27
Q

some reported dietary triggers of migraine

A

Tyramine

MSG

28
Q

Cluster HA criteria

A

A. atleast 5 attacks
B. Severe unilateral orbital, supraorbital and/or temporal pain lasting 15 to 180 mins
C. HA associated w some eye condition
D. 1 every other day to 8x/dau

29
Q

series of events form cluster HA attack

A
  1. predisposition and initiation of attack
  2. Pain (vasoactive intestinal peptide)
  3. Cranial parasympathetic activation
  4. Occulosympathetic failure
30
Q

Cervicogenic headache criteria

A

A. Pain referred from a source in neck and perceived in one or more regions of head
B. Clinical/lab/imaging of disorder in neck
D. pain resolves within 3m after successful tx of causative disorder

31
Q

Cervicogenic HA pattern

A 
Pain unilateral
strongest in orbit/temple
-Also present in upper post neck
-Not disabling to ADLs
-No nausea/phono/photophobia

cd 3303 (24 decks)

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