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MJ- F2 E4- Neuro > Headaches (primary HAs)- MJ > Flashcards

Headaches (primary HAs)- MJ Flashcards

1
Q
  • What age group are tension headaches MC in?
  • MC in men or women?
A
  • Mid teens to < 50 (uncommon > 50)
  • M >W (3:2)
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2
Q

What are the 4 risk factors of tension-type headaches?

A
  1. Stress
  2. Fatigue
  3. Noise
  4. Glare

(“Some Noise Gives Father tension headaches”)

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3
Q

The following is the proposed etiology of which type of headache?

  • Peripheral activation/sensitization of pericranial myofascial nociceptors
  • Decrease nociceptor threshold
  • Normally innocuous stimuli are misinterpreted as pain
  • Prolonged nociceptive stimuli from pericranial myofascial tissues sensitizes pain pathways in the CNS
A

Tension type headache

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4
Q

The following are clinical findings of which type of headache?

  • Daily/episodic HAs lasting from 30 minutes to 7 days
  • Bilateral
  • Pressing / tightening quality (non-pulsating)

•Mild or moderate intensity

  • Photophobia / phonophobia are rare
  • Not increase with activity

•No N/V

•May have increased tenderness of pericranial myofascial tissue

A

Tension headache

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5
Q

Does tension headache normally have N/V, photophobia and phonophobia? If not, what headache is this usually seen in?

A
  • No N/V, photophobia/phonophobia are rare
  • these are seen in migraines
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6
Q

What is acute 1st line tx for tension headaches?

A
  • NSAIDS (Ibu, Naproxen)
  • Acetaminophen
  • Aspirin

*can combine w/ caffeine for increased effect*

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7
Q

What should you NOT use for acute tx of tension headaches?

A
  • Opioids
  • Butalbital (Fiorinal,Fioricet)
  • Muscle relaxants
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8
Q

What are 5 non pharmacologic treatments for tension headaches?

A
  • Biofeedback
  • CBT
  • Relaxation techniques
  • Acupuncture
  • PT

(“PT’s eat CARBs”)

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9
Q

What is the pharmacologic treatment for chronic tension headaches (>7-9 HAs/month)

A
  • Tricyclic antidepressant (Amitriptyline or Nortriptyline)
  • May reduce frequency and intensity of attacks
  • Start with low dosage
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10
Q

What 2 other antidepressants can be used as treatment for chronic presentation of tension headaches (>7-9 HAs/month) if there is a contraindication for tricyclic antidepressants?

A

Mirtazapine

Venlafaxine

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11
Q

Which 2 anticonvulsants can be used as treatment for chronic presentation of tension headaches (>7-9 HAs/month)

A

Topiramate

Gabapentin

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12
Q

What are all of the pharmacologic treatment options for chronic presentaton of tension headaches ( >7-9 HAs/month)?

A
  • Tricyclic antidepressants (ex: Amitriptyline, Nortriptyline)
  • Other antidepressants (if tricyclic contraindicated)
    • mirtazapine
    • venlafaxine
  • Anticonvulsants
    • Topiramate
    • Gabapentin
  • Tizanidine
  • Trigger point injections- Lidocaine
  • Botox
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13
Q

Who are cluster headaches most common in? (gender, age)

A

Most common in:

  • Men
  • > 30y/o (peak in 40s)
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14
Q

Which type of headache is the least common primary headache disorder?

A

Cluster headaches

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15
Q

The following are risk factors for which type of headache?

  • Genetics (1st degree relative= 14 fold increase)
  • Cigarette smoking
  • Prior head injury
  • High alcohol consumption
  • Type A personality
A

Cluster headache

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16
Q

The following is the pathophysiology behind which type of headache?

  • Hypothalamic activation with secondary activation of the trigeminal-autonomic reflex
A

Cluster headache

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17
Q

The following are triggers of which type of headache?

  • Alcohol
  • Stress
  • Glare
  • Specific foods
  • Disorder of circadian rhythm
  • Sleep (reduced oxygenation)
  • Sildenafil
  • Volatile smells
  • Vasodilators
  • Smoking
A

Cluster headache

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18
Q

The following is the clinical presentation of which type of HA?

  • HA 15-180min up to 8x/day
  • unilateral (usually eye/temporal)
  • pain peaks w/in 10-15 min
  • Often at night (nighttime awakenings)
  • Severe, piercing, boring, exploding, penetrating
  • Individuals are agitated and restless
A

Cluster headache

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19
Q
A
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20
Q

What are the 2 forms of cluster headaches?

A
  1. Episodic (MC)- attack phases last 2-16wks followed by cluster free period of 6mo-years
  2. Chronic- No sustained cluster free episodes >1mo
21
Q

Patients with cluster headache should have at least 1 of what 6 symptoms on the affected side?

(“My Cute Pet Louie Runs Noisily”)

A
  1. Conjunctival injection
  2. Lacrimation
  3. Nasal congestion
  4. Rhinorrhea
  5. Ptosis
  6. Miosis

(“My Cute Pet Louie Runs Noisily”)

22
Q

What is the 1st line treatment for a patient with an acute episode of a cluster headache?

A
  • **100% O2**
  • Sumatriptan SC (contraindicated in CVD), or intranasal zolmitritptan
23
Q

Other than 100% O2, that are the 4 other options for tx of an acute episode of cluster headache?

A
  1. Intranasal lidocaine
  2. Oral ergotamine
  3. IV dihydroergotamine
  4. Glucocorticoids (to help bridge)
24
Q

When a patient presents with a cluster headache, you want to start treatment for the acute attack as well as preventative tx. What medication can you use to help bridge this?

A

Glucocorticoids

25
Q
A
26
Q

T/F: Treatment for cluster headaches (like O2) is good for aborting individual attacks

A

TRUE

27
Q

When is there a poor prognosis for patients with cluster headache?

A

•Poor prognosis if not diagnosed and successfully treated (reduced QoL, increased depression)

28
Q
A
29
Q
  • What is the best preventative/prophylactic treatment for cluster headaches?
  • When is this medication contraindicated?
A

Verapamil

(Contraindicated in heart block and arrhythmias)

30
Q

Other than verapamil (most effective), what are 2 other options for prophylactic/preventative tx of cluster headaches?

A
  • Greater occipital nerve block
  • Surgical and neurostimulation options being investigated
31
Q
A
32
Q

What is unique about a new daily persistent headache as opposed to other headaches?

A

Pt is able to identify exact moment in time when they first got headache

33
Q

Are New Daily Persistent Headaches common or uncommon? What population do they affect the most (age, race, ethnicity)?

A
  • Uncommon
  • All ages, races, ethnicities
34
Q

Which type of headache is an acute onset of a chronic headache? (can persist x years)

A

New Daily Persistent Headache

35
Q

What is the duration of a New Daily Persistent Headache?

A

2.5-24hrs/day

36
Q

What are the common characteristics of a New Daily persistent Headache?

  • Location?
  • Intensity/character?
  • Associated sxs?
A
  • Bilateral
  • Moderate intensity- throbbing/pressure-like
  • Assoc. sxs: nausea, photophobia and phonophobia
37
Q

What is the treatment for New Daily Persistent Headaches?

A

Preventative tx for migraine or tension headache

38
Q

The following is criteria for which type of headache?

  • Distinct and clearly remembered onset, with pain becoming continuous and unremitting within 24 hours
  • Pain may be migraine-like or tension-type-like, or have elements of both
  • Present for ≥ 3 months
A

New Daily Persistent Headache

39
Q

What PMHx question is important to ask when interviewing a patient with c/o headache?

A
  • History of headaches? Is this similar to prior headaches? If not, what are normal headaches like?
  • History of CA, neuro dz, HTN, immunosupppresion
40
Q

The following sxs are considered what?

  1. Sudden onset (“thunderclap”)- SAH
  2. New onset headaches > 50 y/o
  3. New onset or severe headache in pregnant or post-partum patient (eclampsia, clots)
  4. Worst or first severe headache of life
  5. Change in pattern/severity of chronic headaches
  6. PMHx of CA, immunocompromised, or increased risk of coagulopathy
A

Red Flags

41
Q

The following sxs are considered what?

  1. Awakening from sleep
  2. Persistent morning HAs w/ nausea
  3. Brought on by exertion or with postural changes or worsens with coughing, lifting, or bending
  4. Weight loss (malignancy)
  5. Altered Mental Status
  6. Fever, nuchal rigidity
A

Red flags

42
Q

The following sxs are considered what?

  1. Focal neuro deficits
  2. Globe tenderness
  3. Papilledema
  4. Tender temporal artery (temporal arteritis)
  5. Severe HTN
A

Red Flags

43
Q

When should you order a CT/MRI for a patient with c/o headache?

A

If you suspect bleed or mass

(if looking for bleed, do CT w/o contrast)

44
Q

What is the location for Migraines vs. Tension vs. cluster headaches?

A
  • Migraines= unilateral (majority of kids have bilateral)
  • Tension= bilateral
  • Cluster= unilateral (around eye or temple)
45
Q

Compare the classic characteristics of migraine vs. tension vs. cluster headache?

A
  • Migraine: gradual, pulsating, moderate-severe, aggravated by routine physical activity
  • Tension: pressure/tightness that waxes and wanes
  • Cluster: abrupt onset; reaches crescendo w/in minutes; pain is deep, continuous, excruciating and explosive
46
Q

Which type of primary headache?

  • abrupt onset
  • reaches crescendo w/in minutes
  • pain is deep, continuous, excruciating and explosive
A

Cluster

47
Q

Compare the patient appearance of someone w/ migraine vs tension vs cluster headache?

A
  • Migraine: pt wants to rest in dark, quiet room
  • Tension: pt may remain active or want to rest
  • _Cluster: p_t is restless
48
Q

Compare the duration of migraine vs tension vs cluster

A
  • Migraine: 4-72hrs
  • Tension: 30min-7days
  • Cluster: 15min-3hrs
49
Q

Compare the associated sxs of migraine vs tension vs cluster headaches

A
  • Migraines: N/V, photophobia, phonophobia, +/- aura
  • Tension: none
  • Cluster: Ipsilateral lacrimation and redness of the eye, stuffy nose, rhinorrhea, pallor, sweating, horner syndrome, restlessness or agitation

MJ- F2 E4- Neuro (19 decks)

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