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CONA 2 > HEADACHES MT #1 > Flashcards

HEADACHES MT #1 Flashcards

1
Q

HEADACHES——-Demographics

1—Up to _____% of men and ____% of women experience at least one headache a month
2–Accounts for 112 million “bedridden days” per year
3–Arguably the most common reason for OTC meds
4–Headache may be present alone or a secondary sequel to whiplash

A

58

76

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2
Q

HEADACHES—Basic Types of Headaches X 2

1————Primary
A–Migraine
B–Tension type
C—_________

2------------Secondary
A--\_\_\_\_\_\_  
B--Tumor 
C--Exertional  
D--\_\_\_\_\_\_\_\_\_
E-Cervicogenic
F--Metabolic/toxic  
G--Infection
A

Cluster

Traumatic

Vascular

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3
Q

HEADACHES—-Primary (1°) Headaches

1----Migraine
A--with aura
B--without aura
2---\_\_\_\_\_\_ \_\_\_\_\_\_\_
3--Cluster
A

Tension type

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4
Q

HEADACHES—–Secondary (2°) Headaches

1—__________=
—-Cerebral contusion, sub-or epidural bleed, intracranial artery bleed, fracture
2—Tumor
3—_________(non- migraine)
—-Atherosclerosis, TIA, stroke, aneurysm, hypertension, temporal arteritis
4—Cervicogenic

A

Traumatic

Vascular

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5
Q

HEADACHES—–Secondary (2°) Headaches

5—Metabolic/toxic
—Uncontrolled DM, thyroid disorder, allergy
Toxic exposure, drug use, drug withdrawal, hangover, etc…
6—___________
—Sinus, meningitis
7—Miscellaneous
Eyestrain, glaucoma, csf alteration, TMJ syndrome

A

Infection

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6
Q

HEADACHES–Examination Red Flags

1---Unequal pupil size (anisocoria)
2--Papilledema
3--Nystagmus (except for normal types)
4--\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_ (if family present, then they will be able to tip you off)
5---Convulsions = Call 911
A

Personality changes

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7
Q

HEADACHES–International Headache Society Criteria

Headaches classified according to following:

1) NUMBER of ATTACKS
2) DURATION of attacks
3) _________ and ___________ of pain
4) NUMBER of associated SYMPTOMS

A

LOCATION

QUALITY

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8
Q

HEADACHES—Migraines

1–Prevalent in ____% of males and ____% of females
2–Menarche - early 20s
3–Less frequent after age ______
4–May present with or without an aura
5–Incapacitating (OTC medications do NOT help)
6–Increase with physical activity
7–Possibly related to familial history
8–Neurologic causing a vascular or inflammatory response?
9–Pulsatile (throbbing), unilateral, changes sides
10–Specific food triggers:
—Wine, chocolate, caffeine, cheeses, cured meats, etc.
11–Nausea/vomiting

A
  1. 5
  2. 2

40

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9
Q

HEADACHES–Proposed Causes of Migraines

1) ________ imbalance
2) VASCULAR inflammation causes irritation of meningeal nerve fibers
3) Inherited ___________ metabolism alteration
4) Trigeminal afferent input and upper spinal nerve input convergence in the trigeminocervical nucleus (resulting in misinterpretation of pain origin)
5) Hormonal effect of ESTROGEN depletion

A

Serotonin

dopamine

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10
Q

HEADACHES—-Phases of Migraines

NAME ALL 5

A

1) Prodrome
2) Aura
3) Headache
4) Headache termination
5) Postdrome

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11
Q

HEADACHES–Migraines without Aura
(COMMON Migraine)

1–Accounts for_____-______% of migraines
2–Female > male
3–Due to DECREASED cerebral BLOOD flow
4–Unilateral severe, pulsatile headache lasting hours to days (1-3+)
5–Associated with nausea and vomiting (gives relief)
6–May have ________&___________
7–CHRONIC migraines = >15 episodes/month for 3 months

A

80-85%

photophobia and phonophobia

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12
Q

HEADACHES–Migraines with Aura
(CLASSIC Migraine)

1–Female > male
2–Unilateral pain lasting hours to 3 days
(with or without nausea and vomiting)
3–Females have increased risk of stroke if they take oral contraceptives, HRT, and/or smoke
4–___________/vasomotor in nature
5–Occur 1-2x/ month

A

Neurogenic

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13
Q

HEADACHES—-Prodrome = is an Aura (

A

Sensory

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14
Q

HEADACHES–Migraine with Aura

1—Aura > ______ min = complicated migraine
–Ophthalmoplegic (Retinal)
–Hemiplegic
–Basilar
NOTE: Must rule out transient ischemic attack (TIA)

A

30

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15
Q

HEADACHES—-Treatment of Migraine

1–May respond to CMT (or may get worse)
2–Biofeedback, acupuncture
3–Nutritional support
–5-HTP, omega-3 fatty acids, magnesium, calcium, vitamin D, riboflavin, feverfew

A

KNOW

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16
Q

HEADACHES—-TENSION Headaches

1–Usually _________, suboccipital, supraorbital, or band-like headaches (temporal: WORSE in the AFTERNOON or early evening)
2–Occurs more frequently than _________ (38%)
3–Female > Male
4–Lasts for days to weeks, frequent in occurrence
5–Often have associated ______muscle tenderness, and HEAD muscle tenderness
6–NO nausea or vomiting, may have one of photo or phonophobia (NOT both)
7–NSAIDs help

A

bilateral

migraines

neck

17
Q

HEADACHES–CLUSTER Headache
(Trigeminal Autonomic Cephalgia)

1—Middle aged male with severe and uniorbital in location peaking within 15 min and lasting

A

smoking or alcohol

histamine headaches

18
Q

HEADACHES–Cluster Headache–Diagnosis

1) At least 5 previous attacks of severe ________, orbital, supraorbital, or temporal pain lasting 15-180 minutes without treatment must have occurred.

2) Headache must be associated with at least one of the following signs which has to be present on the SAME side as the pain:
- Conjunctival injection
- ___________
- Nasal congestion
- Rhinorrhea
- Forehead & facial swelling
- Miosis
- Ptosis
- ______ ________

3) Frequency of attacks is 1 - 8 per day

A

unilateral

Lacrimation

Eyelid edema

19
Q

HEADACHES–Cluster Headaches

1--Males > females
2--Agitated during the attack
3--May present with \_\_\_\_\_ syndrome (5%)
Ptosis
Miosis
Anhydrosis
A

Horner’s

**Horner syndrome is a relatively rare disorder characterized by a constricted pupil (miosis), drooping of the upper eyelid (ptosis), absence of sweating of the face (anhidrosis), and sinking of the eyeball into the bony cavity that protects the eye (enophthalmos). These are the four classic signs of the disorder.

20
Q

HEADACHES–Cervicogenic Headache-Diagnosis

1–Pain is precipitated or exacerbated by neck __________, or sustained neck_________.

2—X-Ray shows one of the following:

1) Movement abnormalities in ________/____________
2) Abnormal posture
3) Distinct bony pathology (other than spondylosis)

3—–Neck and suboccipital pain with TP or facet referral to the head/face
======One of the following:
1) Resistance to or limitation of PROM
2) Changes in neck muscle tone, contour, texture, or response to AROM/PROM/RROM
3) Abnormal tenderness in the C/S paraspinal mm

A

movement

posture

flexion/extension

21
Q

HEADACHES—Cervicogenic Headaches

1–Daily headaches without _____ __________
2–Neck pain/trauma is associated
3–Trigeminocervical nucleus
4–Usually unilateral (but can be bilateral—estimated at 18%)

  • —-Pain referral patterns:
    1) Extrasegmental (myofascial)
    2) Intrasegmental (trigeminocervical nucleus)
    3) Intersegmental

NOTE: Must rule out ___________

A

neurologic signs

meningitis

22
Q

HEADACHES—Temporal Arteritis Headache

1–Newer onset unilateral, temporal HA in patient >50
2–__________ temporal location
3–Tender hard nodule over the temporal artery
4–__________ (may also be associated with visual dysfunction, sudden blindness in that eye, muscular fatigue–polymyalgia rheumatica)
5–Elevated ESR and positive C-reactive protein
6—Refer immediately

A

Unilateral

Vasculitis

23
Q

HEADACHES–Hypoglycemic Headache

1–Headache caused by diabetic becoming hypoglycemic (______ __________)
2–Nondiabetics may get headache also
Usually ___________ and steady
3–Missing or delaying meals cause headaches (especially in migraineurs)
4–Treatment: Eat regularly and avoid high CHO meals

A

insulin shock

bilateral

24
Q

HEADACHES—Sexual Headache

1—___________ headache (occurs at height of sexual arousal)
2–___________, severe, throbbing (I’m describing the headache)
3–Lasts from minutes to hours (I’m describing the . . . never mind …)
Evaluate patient for subarachnoid hemorrhage or other serious illness (vomiting & loss of consciousness are signs of subarachnoid hemorrhage)

A

Exertional

Bilateral

25
Q

HEADACHES–TMJ Referral Headache

1–Usually _________ (location: temporal area)
2–Worse in MORNING (due to grinding all night)
3–Worsens or relief with _________
4–Could be associated with jaw pain, popping, or clicking

A

unilateral

chewing

26
Q

HEADACHES—Sinus Headache

1–Headache over ______OR_________sinuses
2–Quality: Dull
3–Worsens with putting head down or in the morning
4–May have post nasal drip or URI
5–Secondary to ________ factors (ie: Santa Ana winds)

A

frontal or maxillary

environmental

27
Q

HEADACHES—Weight Lifter’s Headache

1—Decreased cerebral flow due to increased _________ __________
2–Positive Valsalva maneuver
3–Associated with dehydration or strain of the cervical musculature (abnormal neck position)

A

intracranial pressure

28
Q

HEADACHES—Visual Headache

1—From sustained eye strain
Usually located in frontal region
but may be found referred to _______ ________

A

entire head

29
Q

HEADACHES—Tumor Referral Headache

1–No prior history
2–Worsening over time
3–Increased with bending over
4–Increased with __________
5–Possibly associated with ________cranial nerve function (depending on location of lesion)
6–Could be associated with altered ophthalmoscopic exam

A

exertion

altered

30
Q

HEADACHES—Aneurysm Referral Headache

1–No prior history
2–“___________” or “sentinel” presentation
3–Increased with exertion
4–Increased with bending over
5–Possibly associated with altered cranial nerve function
6–_______ _______ may be abnormal

A

Thunderclap

Vital signs

31
Q

HEADACHES—Headaches in Children

U p to \_\_%  children age 5--15 and 28%
 of adolescence experience migraines 
Caffeine in soda?
Aspartame in soda?
Sucralose in “thirst quenchers”?
“Ace K” in energy drinks?
A

10%

32
Q

HEADACHES—Why Continue Care??

  • -Some headaches are ____ ______ (don’t expect to cure everyone)
  • -Goal: Reduction in frequency or intensity
  • -Improved coping skills/improved performance of ADLs
  • -Decrease dependence on _________
A

life long

medication

33
Q

HEADACHES—Bell’s Palsy

1–Paralysis of the facial nerve (VII) secondary to _________or __________ where it emerges from the stylomastoid foramen
2–Effects the muscles of the face (1/2) motor and sensory
3—Inflammation can be due to
1) Otitis media (may cause ear pain—duh)
2) Viral infection
3) “Chilling”
4) Tumor

A

cinflammation or trauma

34
Q

HEADACHES—-Bell’s Palsy–Signs and Symptoms

1–Men usually complain that shaving feels different on one side
2–Inability to close one eye, decreased _______
3–Decreased_________ (anterior 2/3 of tongue)
4–Hyper- or hypo-acusis
5–Inability to perform functions related to CN VII
6–Usually complete recovery in 2-8 weeks
7–Patients often fearful that they are having a stroke (need reassurance)

A

tearing

taste

35
Q

HEADACHES–Management For Bell’s Palsy

  • -CMT, acupuncture
  • –MD will give corticosteroids
  • -Keep eye lubricated (possibly covered), wear sunglasses
  • Rule out stroke, TIA, and tumor
  • -Usually remission within a few months
  • -10% of patients may have residual loss of function
A

know

36
Q

HEADACHES—Trigeminal Neuralgia (Tic Douloureux)

—Sudden attack of excruciating pain of short (1-15 minutes) duration along the distribution of the 5th cranial nerve
(V-2,V-3)
–Precipitated by mild stimulation of the trigger zone, chewing
–Mydriasis during the attack (Seeligmuller’s sign)
–Frequency of attacks vary, usually electrical
—Usually _______
–Atypical form may present with constant pain between attacks (usually associated with trauma or multiple sclerosis)
–Females > males
–Mid- to late-life

A

unilateral

37
Q

HEADACHES–Glossopharyngeal Neuralgia

  • –Pain deep in the _____ _______, tongue, throat or palate (CN IX), usually at night
  • –Triggered by talking, swallowing, talking, or chewing
  • –Unknown etiology
  • -Age of onset: usually > 40 years
  • –Medical treatment: Medication, surgical decompression of the nerve (if applicable)
A

oral cavity

38
Q

HEADACHES—Management for TN or GPN

  • –CMT (particularly _______ cervicals)
  • -Avoid triggers
  • -Chew on other side of mouth
  • -Drink liquids at room temperature (avoid “chilling”)
  • -Acupuncture has shown promise
  • -Co-management with MD (meds, surgical decompression)
A

upper

CONA 2 (7 decks)

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