ICS-Headache Flashcards
What type of headaches present with papilledema, meningeal irritation, cranial nerve disturbances and peripheral weakness or sensory changes?
Secondary headaches will present with associated neurological symptoms. Examples include tumors, infections (meningitis), hemorrhages, stroke and arteritis.
Historical red flags for secondary headache disorders.
Thunderclap headache, progressive headache, new daily persistent headache, abnormal neurological exam, change in headache pattern, awakens from sleep and exertional headaches.
Past medical history red flags for secondary headaches.
Cancer, HIV, extracranial infection, Tb, Sarcoid, new headache during pregnancy or after delivery.
Physical exam red flags for secondary headaches.
Fever, stiff neck, nausea, vomiting, papilledema, cognitive impairment, personality changes, seizures
What are the 3 types of primary headaches?
Migraine, tension, cluster
Criteria for migraine w/o aura.
5+ attacks, each lasting 4-72 hours. At least 2: unilateral, pulsating, moderate to severe intensity, aggravated by routine activities. At least 1: nausea, vomiting, photophobia, phono phobia. Finally, exam does not suggest secondary headache.
Criteria for migraine w/ aura.
2+ attacks. At least 3: aura is reversible, develops gradually over 4 min., terminates by 60 min., headache follows aura by < 60 min. Finally, exam does not suggest secondary headache.
Which type of migraine is most common?
W/o aura.
What are common migraine triggers?
CN I (odors), CN II (lights), CN V (temperature & pressure changes), CN VIII (motion).
Types of acute treatment for migraines
Abortive (triptans & ergots, but never used together) & symptomatic (antiemetics, NSAIDs, muscle relaxants and rarely opioids)
Types of preventative treatment for migraines.
Beta blockers, TCAs, Ca channel blockers, BONT and anticonvulsants.
When should you think about prescribing someone preventative migraine therapy?
2+ per week, significant interference w/life
Why guard a patient from rebound headache when treating them?
It can be more difficult to abort
Triptan site of action
5-HT1 agonist
Why can you try a different triptan on a patient that had no success with a previous triptan?
There is no class effect with triptans. You can also change the three F’s: fast vs. slow, formulation and formulary.
Slow acting triptans
Naratriptan and frovatriptan. All the others are fast acting.
Why prescribe triptans over ergots?
Acts on many receptors and has many side effects.
Tension headache criteria
At least 2: tight quality, mild/moderate intensity, bilateral, no aggravation w/daily activities. Both: nausea or vomiting and photophobia or photophonia
A patient comes to see you complaining of daily headaches. He says that he has to take tylenol every single day or else he will get one. What might this guy have?
Medication overuse headache. The brain produces a headache in order to get the medication it has become accustomed to get daily.
Criteria for cluster headache
5+ attacks, unilateral eye or temporal pain lasting 15-180 min untreated. At least 1: conjunctival injection, lacrimation, nasal congestion, sweating, miosis, ptosis, eyelid edema. 1-8x per day.
Acute treatment for cluster headache
Oxygen, subQ triptan, intranasal lidocaine, DHE, prednisone.
Preventative treatment for cluster headache
Verapamil, lithium, ergotamine.
Drug given at high dose for 7-10 days to abort ongoing cluster attack.
Predisone
Diagnostic treatment for cluster attacks if symptoms resolve after 10-15 min.
Oxygen
