MDT Headache Flashcards
Headaches are one of the __________ at 12 to 16% of the population in north America
most common medical complaints
Differential Diagnosis / Danger Signs
Sudden onset or “thunderclap” headache could be
subarachnoid hemorrhage (SAH)
Differential Diagnosis / Danger Signs
Absence of prior headache/s similar to present one Could be
CNS infection
Differential Diagnosis / Danger Signs
Focal neurologic signs other than auras
Could be stroke or tumor
Differential Diagnosis / Danger Signs
Other physical symptoms like fevers
Could be meningitis
Differential Diagnosis / Danger Signs
Rapid onset with exercise Could be
intracranial hemorrhage associated with brain aneurysm
Differential Diagnosis / Danger Signs
Associated with nasal congestion
Could be sinusitis
Differential Diagnosis / Danger Signs
Associated with papilledema
Could be increased intracranial pressure
Reasons for What
(1) Recent change in pattern, frequency, or severity of headaches
(2) Progressive worsening despite therapy
(3) Focal neurological deficits or scalp tenderness
(4) Onset of headache with exertion, cough, or sexual activity
(5) Visual changes, auras, or orbital bruits
(6) Onset of headache after age 40
(7) History of trauma, hypertension, fever
imaging
Overview and presentation of what?
1) Most prevalent headache
2) Bilateral headaches
3) Often occurs daily
4) Characterized as “vice-like” in nature
5) Often exacerbated by emotional stress, fatigue, noise, glare
6) May be associated with hypertonicity of neck muscles.
Tension Headaches
Do you need to do any diagnostic tests for Tension headaches?
no
What meds can you use to treat a Tension headache
Abortive
-NSAIDS
(1 Ibuprofen (Motrin) 400- 800 mg PO q 4- 6 hours, Max
2400mg/24 hours
(2 Naproxen (Naprosyn) 250- 500 mg PO q12 hours
-Tylenol
(1 Dose: 325-1000 mg PO q 4-6 hours, max 4 grams/24 hours
Contraindications: Hepatic or renal impairment, chronic alcohol
abuse
Overview and presentation of what?
1) Usually affects middle aged men but can also affect women
2) Intense unilateral pain that starts around the temple or eye
3) Patients is often restless and agitated due to the pain
4) Episodes often occur 15 minutes to 3 hours
5) Usually occur seasonally and attacks are grouped together
6) Other associated symptoms
a) Ipsilateral congestion or rhinorrhea
b) Lacrimation and redness of the eye
c) Horner syndrome (Ptosis, miosis,
anhidrosis)
7) After resolution of attacks there is a hiatus of several months
Cluster headache
Oral treatment for ______during an attack is generally _______
Cluster headache
unsatisfactory
Treatment for cluster headache initial treatment of choice
Inhaled 100% oxygen for 15 minutes is initial treatment of choice
Treatment for cluster headache Subcutaneous Sumatriptan (Imitrex) Dose: MOA: Adverse reactions:
Dose: SubQ Initial: 6 mg; may repeat if needed ≥1 hour after initial dose
MOA: Selective agonist for serotonin causes vasoconstriction and reduces neurogenic inflammation
AR: Tingling, dizziness/vertigo, feeling hot
Treatment for cluster headache Oral Zolmitirptan (Zomig) Dose: MOA: AR:
Dose: Initial: 2.5 mg, may repeat if needed ≥ 2 hour after initial dose
(maximum single dose: 10 mg per 24-hour period).
MOA: causes vasoconstriction and reduce neurogenic inflammation associated
with antidromic neuronal transmission correlating with relief of migraine
AR: Gastrointestinal unpleasant taste, chest pain,
weakness, dizziness/vertigo, feeling hot.
How long do cluster headaches usually last?
15 min to three hours?
Overview and presentation of what?
1) Gradual build-up of a throbbing headache, that may be unilateral or bilateral
2) Duration of several hours
3) Aura may or may not be present
a) Visual disturbances such as visual
field deficits or visual hallucinations
(stars, light slashes, zigzags, etc)
b) Other focal disturbances such as
aphasia or numbness, tingling,
clumsiness, or weakness in a
circumscribed distribution
4) Family history often positive for headaches
5) May have associated nausea and vomiting
Migraines
Migraine management
1) Avoidance of precipitating factors, together with prophylactic or symptomatic
pharmacologic treatment if necessary.
2) During acute attacks - rest in a quiet, darkened room until symptoms subside.
Migraine Abortive Treatment
a) Simple analgesics/NSAIDS: Ibuprofen, Naprosyn, Aspirin, Acetaminophen, Ketorolac (Toradol) 30mg IV/IM once or every 6 hours or 60mg IM once (max 120mg/day)
b) Sumatriptan (Imitrex) Oral dose of 25, 50 or 100mg. repeat in 2 h if needed. REC 50mg and 100mg initial more better
c) Zolmitriptan (Zomig) 2.5 mg q>2H (max 10 mg)
Migraine Prophylaxis
1) Preventative treatment indicated when migraines occur more than 2-3 times per month or associated significant disability.
2) Antihypertensives: Beta-blockers such as Propranolol, Metoprolol
3) Antidepressants, amitriptyline
4) Anticonvulsants: topiramate
5) Treatment for concurring symptoms like nausea and vomiting antiemetics: promethazine
Overview and presentation of what?
1) After head injury, it is common to have headaches
2) Symptoms occur within 1-2 days of injury, and subside within 7-10 days
3) Often accompanied by impaired memory, poor concentration, emotional
instability, and increased irritability
Post-Traumatic Headache
Post-Traumatic Headache
Treatment
1) No special treatment required
2) Simple analgesics are appropriate first line therapy
Overview and presentation
1) Present in about 50% of patients with chronic daily headaches
2) Patients typically present with chronic pain or with complaints of headache unresponsive to medication
3) History will often reveal heavy use of analgesics
Medication Overuse Headache
Medication Overuse Headache
Treatment
1) Treatment is to withdraw medications….
a) Expect improvement in months, not days
