Headaches/Migraines

Question 1

Criteria of migraine w/o aura

Answer 1

• 5+ attacks with the following:
• headache for 4-72h
• headache as at least 2 of these things: u/l, pulsating, moderate-severe intensity, aggravated by physical activity
• N/V, photophobia, phonophobia (1)
• H&P or tests do not show another etiology

Question 2

criteria of migraine w/ aura

Answer 2

• 2+ attacks that have at least 3 of the following:
• 1 or more reversible aura
• 1+ aura symptoms develops over 4 minutes or 2+ symptoms in succession
• no aura lasting more than 1h
• headache follows aura
• H&P and test show no pathology

Question 3

types/examples of auras

Answer 3

• aura = warning sign for a migraine
• lasts 15-30minutes and happens before, during or after head pain begins
  1. visual - scintillating scotoma, fortication spectra
  2. paresthesias - numbness in face/hands
  3. weakness - hemiplegia on one side
  4. aphasia
  5. vertigo
• migraine equivalent: 1 of these happens by themselves w/o the headache

Question 4

prodrome and symptoms

Answer 4

• premonitory phenomena preceding headache by hours to days
• symptoms include: mental and mood changes, stiff neck, chilled feeling, increased urination, anorexia, bowel changes, food cravings, fluid retention
• not the same as auras

Question 5

migraine: pathophysiology

Answer 5

• aura phase associated w/ reduction in cerebral blood flow
• spreading of oligemia at 2-3mm/min
• oligemia progression doesn’t respect vascular territories
• oligemia seen in migraines w/ and w/o aura
• phenomenon = “spreading depression”
• pain generated by sterile neurogenic inflammation
• CGRP gene release via trigeminovascular system that is activated as protective mechanism in response to oligemia

Question 6

criteria for tension headache

Answer 6

• at least 2 of the following: pressure/tightening quality, mild-moderate intensity, b/l location, not aggravated by exertion
• no N/V, photophobia, phonophobia
• No H&P or tests find other etiology

Question 7

episodic tension headache: frequency/duration

Answer 7

• at least 10 previous headache episodes:
  <15d/month
• headaches last 30 minutes to 7d

Question 8

chronic tension headache frequency

Answer 8

• average headache frequency = >15d/month for longer than 6 months
• psychosocial/psychiatric issues are more common in these pts

Question 9

factors confounding dx of tension headaches

Answer 9

• stress triggers
• b/l or non-pulsating head pain
• presence of neck pain
• in pts w/ these symptoms you need to consider dx of migraines; find a way to r/o one or the other

Question 10

cluster headache criteria

Answer 10

• 5+ attacks fulfilling:
  1. severe u/l orbital, supraorbital, and/or temporal pain lasting 15-180m untreated
  2. Has 1 of the following symptoms on same side as pain: conjunctival injection, lacrimation, nasal congestion, rhinorrhea, forehead/facial sweating, miosis, ptosis, eyelid edema
  3. frequency = 1 every other day to 8 per day
• No H&P or test suggest other dx

Question 11

cluster headache characteristics

Answer 11

• onset younger than 19yo
• male predominance
• usually occurs at night, often at same time each day
• paces or pounds fist or head w/ attack
• may commit suicide

Question 12

criteria for sinus headache

Answer 12

• considered secondary dx from acute sinusitis
• requires presence of purulent nasal discharge and pathologic sinus findings in tests including xray, CT or MRI
• chronic sinusitis is not validated as a cause of headache or facial pain unless relapsing into an acute stage