Lecture 6: Headaches Flashcards
Primary Headache definition
headache itself is the disorder, no other known problem
Primary Headache Red Flags
1) New HA pattern: increase frequency, intensity
2) Known or suspected medical cndtn: immune compromise–> think CNS infxn; prior h/o malignancy –> think mets to brain
3) Morning or Cough HA: aka traction ax’s
4) Age of onset: >50 y/o be suspicious
5) Localized neuro findings: papilledema (think ICP); LOC, seizures, personality/cog changes, visual changes
6) Thunderclap HA: think SAH
7) Meningismus: HA + fever + nuchal rigidity
8) Orthostatic HA: increase HA with standing, resolves when lying down
9) Temportal HA + Jaw Claudication: think temporal arteritis
Migraine quick facts
- 18% women, 8& men
- evidence of migraines in girls/boys equal until menses
- fluctuates during menstrual cycle, pregnancy, completion of menopause
Migraine without aura: ax’s and triggers
- unilateral pain, peaking to throbbing over min-hrs, lasting hrs-days
- N/V, photophobia and phonophobia
- triggers: stress relief from acute stress, hormonal changes, bright lights/strong odors, sleep disturbances
Migraine with aura: sx;s
aka classic migraine
- visual sx’s most common: shimmering, jagged lines, blind spots, homonymous hemianopsia
- arise in 5-10 min and lasts 20 min or longer
Pediatric migraine
- brief spells (30-120 min) of only mild HA
- but with severe abdominal pain, vomiting and vertigo
Risk Factors of Migraine Progression
1) Chronic medical cndtns: can intensify underlying migraine disorder
2) meds rebound HA: caffeine, opioids, barbs, ergots, NSAIDs
3) CHronic Cervical strain: causes painful sensory activity to trigeminal nucleus (region that processes HA pain)
4) Depression/Anxiety Disorder
5) Stress management
6) Poor sleep
8) estrogen
9) tobacco
10) chronic inactivity
11) Body wt
Cluster Headache features
- much less common than migraines
- more common in men
- short duration reaching peak in min and lasting < 2 hrs
- pain: unilateral/periorbital and accompanied by ipsilateral vasomotor sx (tearing, conjunctival injxn, stuffy nose, rhinorrhea)
- may be triggered by alcohol, fall/spring
- pacing around room, hit thmeself in area of discomfort
- tx: high flow O2 and ejectable sumatriptan, verapamil + melatonin
Tension-Type HA
- mild, short lasting
- most commonly during young adulthood, middle age and in females
- pain: bilateral, aching, pressure, band-like
- brief and mild; tx with OTC: and relaxation techniques
Secondary HA
have a medical or neurological cause for HA problem; HA is sx of another cndtn
-examples: Meningitis, Intracerebral hemorrhage, subarachnoid Hemorrhage, temporal arteritis, Pseudotumor cerebri, primary cough HA, intracranial lesions
Meningitis
- acute onset, severe, constant, photophobia, phonophobia, seizure
- PE: fever, meningismus, altered mental status
- Labs: leukocytosis,
- Tx: 3rd gen ccephalosporin, vancomycin, ampicillin, acyclovir, antifungals
Types of meningitis
1) bacterial: neissaria, pneumococcus, H.flu, listeria
2) Viral: HSV, echovirus, mumps, arbovirus
3) fungal: cryptococcus, histoplasma, candida
Intracerebral Hemorrhage
- acute onset, variable, N/V
- on PE: HTN, focal deficit, variable meningismus, lethargy
- location of hemorrhage important clue as to underlying cause
- tx: correct coagulopathy control BP, may need to evacuate or embolize
Causes of intracerebral hemorrhage
- HTN
- Coagulopathy
- amyloid angiopathy
- vascular malformation
- trauma
- drug abuse
Temporal arteritis
- age over 50,
- jaw claudication
- vision loss
- dx: ESR > 80, temporal artery bx
- Tx: steroids, presumptive therapy
