Lecture 9 - Headaches

Question 1

what are 3 primary headache types?

Answer 1

tension
migraine
cluster

Question 2

what are 3 categories of secondary headaches based on etiology?

Answer 2

1. life-threatening conditions (intracranial tumors, bleeding, infections, hypoxia)
2. less serious conditions (caffeine or analgesic withdrawal)
3. systemic illness (fever, HBP, sinusitis)

Question 3

post-traumatic headache is a less specific headache that is associated with…

Answer 3

brain injury that maybe localized to injury site of generalized (common associated complaints in addition to head pain are irritability, LOC, memory loss, dizziness)

Question 4

what are 3 intracranial disorders that are associated with severe headaches?

Answer 4

subarachnoid hemorrhage (SAH)
brain tumor (small %)
meningitis

Question 5

what are 3 traits of severe headaches associated to brain tumor?

Answer 5

disrupts sleep
triggered by exertion
causes excessive drowsiness

Question 6

severe headaches related to intracranial disorders are usually accompanied by other neurological signs such as…

Answer 6

weakness
visual disturbances
altered state of consciousness

Question 7

what is the most common type of primary headache?

Answer 7

tension (90% of adults)

Question 8

what are the 3 subcategories of tension headaches?

Answer 8

infrequent (episodic = less than 12 days/year)
frequent (12-180 days/year)
chronic (more than 180 days/ year)

Question 9

what are 4 etiology and risk factors related to tension headaches?

Answer 9

psychological (catastrophizing)
limbic system (area of interest)
lower levels of blood Mg
increased blood flow in cerebral arteries

Question 10

what 2 hormones are thought to irritate sensory nerves and result in tension headaches?

Answer 10

serotonin and bradykinin

Question 11

T or F: nausea is associated with tension headaches

Answer 11

False

Question 12

what are 3 of the most common precipitating factors of tension headaches?

Answer 12

stress, fatigue, not eating on time

Question 13

amitriptyline is used for ____ tension-type headaches

Answer 13

chronic

Question 14

T or F: migraines are a familial disorder

Answer 14

true

Question 15

migraines are severe recurring headaches, characterized by ____ and. ____ pain

Answer 15

sharp

throbbing

Question 16

migraines are often accompanied by what 4 other symptoms?

Answer 16

nausea
vomiting
light sensitive
visual disturbances

Question 17

T or F: migraines are commonly bilateral

Answer 17

false

Question 18

migraines are widely variable in __________

Answer 18

frequency, intensity and duration

Question 19

what is the second most common type of primary headache?

Answer 19

migraine

Question 20

what % of migraines have family history involved?

Answer 20

60%

Question 21

what syndrome seems to be a common precursor to migraines and children?

Answer 21

cyclic vomiting syndrome

Question 22

individuals susceptible to migraines may also be at risk for other alterations of the nervous system, including….

Answer 22

anxiety
depression
chronic pain

Question 23

what hormone drops during migraine attacks?

Answer 23

serotonin

Question 24

what are 5 co-morbidities relating to migraine headaches?

Answer 24

HTN (stroke)
allergies
Meniere's disease
Lupus
Epilepsy

Question 25

define 'aura'

Answer 25

a sensation perceived by a patient that precedes a condition affecting the brain

Question 26

what are 6 types of migraines?

Answer 26

``` without aura with aura sporadic and familia hemiplegic basilar-type status migrainosus chronic ```

Question 27

basilar-type migraines have symptoms related to the vascular territory of basilar artery, which involves what 3 brain structures?

Answer 27

brain stem cerebellum occipital lobe

Question 28

what are 5 prodromal syptoms?

Answer 28

``` altered conscious tinnitus/vertigo dysarthria ataxia diplopia ```

Question 29

what type of migraine lasts more then 72 hours?

Answer 29

status migrainosus (risk factors: PMS, pregnancy, miscarriage, pill change, med rebound)

Question 30

how frequent must migraines be for them to be considered frequent?

Answer 30

headache 15 or more days for more than 3 months

Question 31

what type is the most rare but also most painful of the primary headaches?

Answer 31

cluster

Question 32

what are the 2 types of cluster headaches?

Answer 32

episodic (80%) | chronic (on for at least 12 months)

Question 33

cluster headaches are correlated with _____

Answer 33

head trauma

Question 34

what are 6 factors that may precipitate a cluster headache?

Answer 34

``` vasodilators alcohol post afternoon nap 90 min after falling asleep sleep apnea hypoxemia ```

Question 35

cluster headaches are usually localized to what area?

Answer 35

one eye and front-temporal region

Question 36

what are 3 contra or bilateral ANS symptoms related to cluster headaches?

Answer 36

photophobia/blurred vision tearing nasal congestion

Question 37

what are 5 diagnostic criteria for cluster headaches?

Answer 37

``` episodic strictly unilateral severe intensity/pain orbital localization short duration ```

Question 38

trigeminal neuralgia/tic douloureux is a cluster-like headache that is one of the most_____ conditions we can suffer from

Answer 38

painful

Question 39

what causes trigeminal neuralgia/ tic douloureux?

Answer 39

anything that presses on trigeminal nerve/branches

Question 40

trigeminal neuralgia can be the first sign of what 3 conditions?

Answer 40

MS DM lack of b12

Question 41

trigeminal neuralgia may cause paralysis of what muscles?

Answer 41

chewing

Question 42

cervicogenic headaches are secondary headaches where pain is localized in...

Answer 42

neck and occipital region, but may project to forehead, orbital region, temples and ears

Question 43

cervicogenic headaches pain is precipitated by/aggravated by....

Answer 43

special neck movements or sustained neck posture

Question 44

what differentiates acute vs chronic post traumatic headaches?

Answer 44

acute develop within 7 days and resolve within 3 months; | chronic begin weeks or months after trauma and persist for years (mild/mod head injuries)

Question 45

what are 4 types of post-traumatic headaches?

Answer 45

tension-like (no nausea, not aggravated by bright light, dull pain) migraine-like (nausea, bright light trigger, pulsating pain) cluster-like cervicogenic-like

Question 46

what is a postdural puncture headache?

Answer 46

disabling headache after lumbar puncture/epidural caused by CSF leakage (3-5 days)