Migranes Flashcards
What is the prevelance of headaches? who tends to experience them msost often?
lifetime prevalence of headaches if 66%
- tends to decline as reach 40 years old
- affects women more than men
*accounts for 20% of work absences
What are the types of primary head aches?
Primary head ache = Not associated with underlying illness
*90% of headaches
- ex: TTH, Cluster, Migrane (vascular, benign external, cold- stimulus)
what are secondary headaches
symptom of an underlying condition
- ex: medication overuse heachache, sinus headache
what are the disease causes of headaches
Infection
temporal arteritis
subdural hematoma
subarachnoid haemorrhage
cerebral ischemia (stroke)
Transient ischemic attack (TIA)
- systemic/CNS vasculitides
- space occupying lesions
What are the drugs hat cause heachaes as a side efect
ACEIs
BBs
CCBs
H2 antagonists
Nitrates
NSAIDs
Oral contraceptives & HRT
Other antihypertensives
SSRIs
What drugs are associated with Intracranial hypertension?
*intracranial hypertnesion = high pressure around brain
**refer immediately
Antibiotics • Corticosteroids • Other
what characteristics define a heachache
Location of pain
Nature
Onset
Duration
Non-headache symptoms
what are the 4 major types of heachaes and where is each located?
Sinus: behind browbone and/or cheekbones
Cluster: prain is in and around one eye
Tension: pain is like a band squeezing the head
Migrane: pain, nausea and visual changes are typical (full head)
Describe TTH
(nature, severity of pain, location, onset, frequency, duration, aggrevation by physical activity, and non heachae assocaited symptoms)
Nature/Quality: Pressing/tightening (non pulsating)
Severity of painL mild - moderate
Location: bilateral
Onset: gradual
Frequenccy: episodic or chronic
DUration: 30 min - 7 days
Aggrevated by physical activity: No
Associated symptoms: muscle pain radiating along trapezius muscles and scalp
Describe Migrane
(nature, severity of pain, location, onset, frequency, duration, aggrevation by physical activity, and non heachae assocaited symptoms)
Nature/quality: trobbing (pulsating)
Sevarity: moderate - severe
location: unilateral (fronto-temporal)
Onset: sudden
Frequency: episodic or chronic
Duration 4-72 hours
aggrevated by physical acitivty: yes
assocaited symptoms: Either N/V or photophobia, phonophobia
Describe Cluster heachache
frequency, duration, aggrevation by physical activity, and non heachae assocaited symptoms)
Nature/quality: Penetrating/stabbing
Sevarity: excurciating
location: unilateral, orbital or temporal
Onset:
Frequency: episodic or chronic
Duration 15- 180 min
aggrevated by physical acitivty: no
assocaited symptoms: Elacrimation, nasal congestion, forehead/facial sweating, eyelid edema
Describe Sinus headache
(frequency, duration, aggrevation by physical activity, and non heachae assocaited symptoms)
Nature/quality: Pressue behind eyes or face
Sevarity: full, worse in AM
location: bilateral: face, forehead periorbital area
Onset: simultaneous with sinus sx
Frequency: N/A
Duration days
aggrevated by physical acitivty: no
assocaited symptoms: occur w/ sinus sx: purulent nasal discharge/congestion
What is the mosst common type of headache
TTH (stress headache)
- pathophysiology not known
*manfiest bc of mental stress, anxiety, depression, emotional conflicts and other stimuli
*Diagnosed by the absense of features found in other types of headache (no N/V)
characteristics of migrane headaches
- recurrent - occur w/ or wi focal neurologica symptoms (aura)
( migrane with aura occurs twice as frequently as migrane with aura )
*when aura is present (15%) is usually precedes the Ha
- 70% of patients have family histories of migrane
Pain sevarity >> TTH (80% will say the apin is severe)
- ass symptoms: nausea and/or vomitting, photophobia and/or phonophobia
- can cause vertigo, tinnitus light headedness and irritabiliy
What are the 4 phaes of migrane type headaches?
- Prodrome: burtsts of energy, fatigure 48hr before heachache
- Aura: visual or auditory (15% of patients)
- Heache
- Postdrome
what symptoms can migrane headaches cause
- Neasuea and/or vomiting, photo and/or phonophobia
Tinnitus,light headedness, vertigo, irritability
* can be aggrevated by or cause avoidance of routine physical activity
What factors will trigger a migrane headache?
What medications can trigger a migrane headache?
Stress, fatigue, oversleeping, fasting/missing a meal, vasoactive substances in food (MSG), caffeine, alcohol, menses, changes in barometric pressure & altitude
Certain Medications: Reserpine, Nitrates, Oral contraceptives, Postmenopausal hormones
describe the characteristics of a sinus type headache
usually reported in patients with acute sinusitis
*if pain si mroe intense when you bend over/ blow nose it acn indicate sincus HA
- assosicated symptoms: upper teeth toothache, facial pain, nasal stuffiness, nasal discharge
*Prevalance is low: 90% of patients who believe they have sinus HA may actually be experiencing migraine headache
describe the characterisitcs of a cluster headache?
uncommone (0.2%)
- onset 25-50 years old
*• Will have several attacks over a period of time, and then goes into remission for months or years
- Associated symptoms: can cause tearing, nasal congestion, rhinorrhea, forehead/facial swelling, miosis and headahe
* if suspect patient of a cluster headache must refer
how are head aches assessed?
- differential diagnosis: rule out seonccdary cause of HA (need to make sure its priamry)
- no diagnostic tests exist for primary HA- its based on symptoms
- pateitns with occasional TTH do not req futher assessment unless headaches become chronic
How should patients decribe head ache?
SCHOLAR
- S: symptoms
- Red flags: fever, cahnges in vision, sensation and consciouesness
- C: characteristics: quality/sevarity (relative)
- is ti worst pain ever
- History of headaches
- how often do you get?
- age of onset?
- how does it compare to past HA
- change in freq, intensity, duration, location, progression
- Response to prev treatments if any
- family histroy of HA?
- O: onset
- L: Location
- A: aggrevating/ previpitating factors/ triggers
- any relationship with food .alc
- Remitting/ releiving factors
What info should you gather on the patient?
- H: health condations
- HTN? recent rrauma? changes in health/activ
- A: allergies
- M: mediactions
- S: Social: smoking, acl use etc
conditions for emergent head ache referral?
SSNOOPP
S: systemic s/s: fever, N/V, appears ill
S: severe (worse HA of life)
N: neurologic s/s: seizures, stiff neck, changes in vision, mental status, impaired consciouness
O: onset is abrupt of new
O: other ass conditions (trauma)
P: prior HA history: sig change in pattern of HA, inc freq and or progressive severity
P: Pain (unilateral eye), fixed and dilated pupil or diminied vision
Conditions for non emergent HA referral?
- an secondary cause of HA
- chronic TTH or freq migranes
- >8 headaches/month - prophilactic therapy
- Suspected MOH or mediaction-induced headache
- 1st HA ever
- occurance at ngiht or on awakening in morning
- potential signal of brain tumor
- patient >50 with new undiagnosed HA
- Patient >50 and HA assocaited with tenderness in the temporal artery
- ONsert w/ excersie or sexual acitivty
- uncrontolled HTN
- Shingles or post- herpetic neuralgia
- inusitis, otitis media or denal abscess
- pain >6