Headaches Lecture

Question 1

Meningeal signs triad

Answer 1

Fever, neck stiffness, mental status change

Question 2

Primary HA

Answer 2

Migraines, tension type, cluster HA

Question 3

Secondary HA

Answer 3

Head trauma, mass, SAH

Question 4

HA red flags

Answer 4

Worst HA of life
New onset HA after age 50 never experienced before
HA pattern: worse lying down increase severity and frequency
Mental status change
Onset with exertion, fever, stiff, rash, ca, hiv

Question 5

SNOOP4 RED FLAGS

Answer 5

S: Systemic DZ or SX 
N: neurologist sx
O: onset sudden
O: older than 40 
P: progressive worsening 
P: postural 
P: precipitated by Valssalva or exertion 
P: previous ha hx w, features

Question 6

Most common HA?

Answer 6

Tension HA

Question 7

FMHX and Migraines

Answer 7

First generation mom dad sisters

Question 8

Subarachnoid Hemmorage

Answer 8

Thunderclap ha, what changed wat made you come in today

Question 9

Subarachnoid hemorrhage

Answer 9

Instant onset, thunderclap ha

Question 10

Cluster HA onset

Answer 10

Develops rapidly over 5-10 minutes

Question 11

Tension type migraine onset

Answer 11

Gets worse over the hour or so

Question 12

Duration migraine

Answer 12

4- 72 hours

Question 13

Tension ha duration

Answer 13

30 min to 1 week

Question 14

Cluster ha duration

Answer 14

15 min-3 hours

Question 15

Turning your head and neck would cause what ha

Answer 15

Cervicogenic ha

Question 16

Touching scalp gives you what type ha

Answer 16

Giant cell arterioles

Question 17

Valsalva gives you what type of ha

Answer 17

Brain tumors, migraine and focal deficits

Question 18

Cluster HA details

Answer 18

One sided around or behind the eye, 30 min to 2 hours, facial sweating one sided tearing, nasal congestion

Question 19

Migraine details

Answer 19

Several hours to 3 days one sided around temple pulsing throbbing, light sensitivity nausea visual disturbances

Question 20

Tension ha details

Answer 20

Both sides of whole head, 30 min up to 7 days, tight shoulder muscles, band like pressure

Question 21

Migraine disorder

Answer 21

Inherited autosomal trait, neural intracranial vasodilation, 2-3 more common in women
Aura: can be visual flashing lights, dysphasia many come without aura

Question 22

Menstruated migraine

Answer 22

2 days before period linked to estrogen withdrawal

To NSAIDS

Question 23

Migraine triggers

Answer 23

Flashing lights, stress, lack of sleep, caffeine, foods, red wine, chocolate, msg, processed meats

Question 24

Migraine clinical features

Answer 24

CNS: elation increase appetite for sweets

Alternatively: depression, irritability, may happen

Happen 24 hours prior

Question 25

Migraine clinical features

Answer 25

Sever throbbing unilateral can be bilateral ha lasting 4-72 hours, having 2/4 of these sx make it a migraine n/v, photophobia

Question 26

Migraine HA TX

Answer 26

Excedrin if mild
Dihydroergotamine DHE

Contraindications: CAD, PREGO, TIA, PAD, SEPSIS

Need: abortive medications and need prophylaxis daily to reduce frequency

Question 27

Migraine TX acute attack

Answer 27

Sumatriptan 5ht1 receptor selective, acts within one hour and is effective , not to be used more tha 1-2 a week, CI: CAD, PREGO, HTN, MAOI,SSRI, LITHIUM

Question 28

Migraine prophalxis rx regime

Answer 28

Must take daily
First line agents beta blockers, tryciclyc acids

Props nooo, amitriptyline, venlafaxine

TCA side effects: dryness

Question 29

Migraine ha prophylaxis second line

Answer 29

Verapamil ccb
Valproate acids or topiramamte
NSAIDs for period migraine