Module 5 EB #1 Flashcards
Red flag sx of acute HA
*what do these red flag sx exclude?
> 40yo
rapid onset
severe intensity
**thunderclap
-onset after trauma or during exertion
-brain tumor, meningitis, stroke, encephalitis, intercranial hemorrhage, temporal arteritis, acute angle glaucoma, raised ICP, CO poisoning, preeclampsia, aneurysm
When to transfer to the ED for acute HA (accompanying signs)?
-fever, vision change, neck stiffness
-neuro findings: mental status change, motor/sensory deficits, LOC
-past medical hx of HTN or HIV
SNOOOPPPPP
-sx of acute HA
-Systemic S or S (fever, wt loss)
-Neurologic S or S (confusion or impaired alertness)
-Onset (sudden)
-Older (>50yo)
-Occipital (back of head; occipital HA in children)
-Previous HA (new, worse, or different?)
-Progressive, persistent HA
-Precipitated by pressure (bearing down, coughing, sneezing)
-Postural HA (worse when supine, worse waking at night, worse in AM)
-Pregnancy
what is the most important component (what info is most important) in regards to acute HA?
onset of HA
-sudden, persistence = subarachnoid hemorrhage
–> especially when preceded by exertional activities
Elements to the neuro exam regarding acute HA
-VS
-Mental Status
-Motor and Sensory
-Reflexes
-Gait (rapid finger-nose testing)
Ottawa SAH clinical decision scale
100% sensitivity in predicting subarachnoid hemorrhage
-40 years or older
-neck pain/stiffness
-witnessed LOC
-onset during exertion
-thunderclap HA (pain peaks w/i 1 sec)
-Limited neck flexion (on exam)
Diagnostic imaging for acute HA
No contrast = visualize bone and surrounding soft tissue (blood vessels)
Migraine
-what type of dysfunction?
-neuronal dysfunction: a wave of activity by groups of excitable brain cells that trigger chemicals that cause dilation of blood cells –> creates HA
*pain felt by pt triggers more chemicals which leads to further dilation of blood vessels and more painT
Tension HA
-cause?
cause unclear
-derivative pain of tension HA has muscular origin
Cluster HA
-mechanism
vascular dilation trigeminal nerve stimulation, have circadian effects
-histamine release, inc mast cells, genetic factors, and autonomic NS activation may also contribute
Which HA does this describe?
Unilateral pain, throbbing, pulsitile
Migraine
Which HA does this describe?
worse with routine activity
Migraine
Which HA does this describe?
onset and duration of HA = 4-72hrs
Migraine
Which HA does this describe?
Accompanying sx: N/V, photophobia, phonophobia
Migraine
Which HA does this describe?
some have aura preceding AH (commonly visual aura)
Migraine
Which HA does this describe?
Family hx of this type of HA present
Migraine
Which HA does this describe?
Patient reports recent lack of sleep, missed meal, menstruation
Migraine
Which HA does this describe?
precranial tenderness with generalized apin described as vice-like, tight
tension
Which HA does this describe?
not pulsitile
tension
Which HA does this describe?
pain worse at base of neck or occipital area of head
tension
Which HA does this describe?
timing: constant daily HA
tension
Which HA does this describe?
no accompanying focal/neuro deficits = NO AURA
tension
Which HA does this describe?
episodes exacerbated by stress, fatigue, noise
tension
Which HA does this describe?
unilateral, temporal or periorbital pain with one or the following:
-ipsilateral sx: nasal congestion, rhinorrhea, lacrimation, redness of eye
cluster