Neuro: HA Flashcards
MC HA Dx
migraine
Most debilitating HA
cluster
Most frequent HA
tension
Triad for migraines…
photophobia
incapacity
nausea
Throbbing, pulsatile HA
nausea confusion blurred vision photo/phonophobia no warning
common migraine
What stage of migraine?
Food cravings, mood change, uncontrollable yawning, fluid
retention, constipation, neck stiffness
prodrome
Unilateral, throbbing pain w/ N/V and/or photo/phonopobia
migraine
Dx of migraine
clinical
Migraine with the below warrants…
- “Worst headache of my life”
- Changes in HA presentation
- New or unexplained neurologic symptoms
- HA not responding to treatment
- New onset after 50 or in pts with CA or HIV
CT
Mod-Severe migraine Tx
triptans
The below are SEs of…
Injection site reaction, chest pressure or
heaviness, flushing, weakness, drowsiness,
dizziness, malaise, feeling of warmth,
paresthesia
• Resolve in 30 minutes
triptans
C/Is for triptans and ergots…
uncontrolled HTN
pregnancy
hx of cardiovascular dz
4 drugs for migraine prevention…
propranolol
amitriptyline
topiramate
CGRP antagonists (umab)
non-throbbing, bilateral band like HA
lasts 30min to 7 days, worsens during day
rare photo/phonophobia
No N/V
tension HA
What classification of TTH?
1-14days a month lasting 30 min-several days
not disabling
frequent
sharp, boring unilateral periorbital pain
autonomic sx (tearing, etc)
excruciating pain
15-180 minutes
cluster HA
describe the course of cluster HA
similar time of day/night x several weeks with remission
Initial diagnostic imaging for cluster HA
MRI with and without contrast
Acute tx of cluster HA
100% O2 NRB 12 L/min x 15 minutes upright
SC sumatriptan
when to not use oxygen with cluster HA
severe COPD
Preventative tx of cluster HA…
verapamil
Moderate pain on sides or top of head 15+ days x 3+ months
chronic migrain, tension
hemicrania continua
continuous, fluctuating pain
on same side of face/head lasting minutes to days
tearing, irritated eyes, rhinorrhea, swollen eyelids
hemicrania continua
Dx and Tx of chronic daily HA…
indomethacin
