Primary Headache Flashcards

Question

acute headaches

Answer 1

-rapid onset -age > 40 years -severe intensity -thunderclap, trauma, exercise onset -fever -vision changes -nuchal rigidity -HIV infection -current or past hx of hypertension -neurologic findings (mental status changes, motor or sensory deficits)

Answer 2

-chronic migraine headache -chronic tension type headache -medication overuse headache (opioids 10, NSAIDS 15) -hemicrania continua- one sided, persistent, responds to indomethacin (NSAID) -new daily persistent headache -chronic daily headache (CDH) is not a specific headache type but a syndrome that encompasses other primary headaches

Answer 3

-subarachnoid hemorrhage -meningitis -subdural hematoma -temporal arteritis -CNS tumor -posttraumatic -primary cough headache -sinusitis -toothache -medication overuse

Answer 4

-vascular causes -infections -intracranial masses -preeclampsia (frontal) -CO poisoning -headache brought on by cough, exertion, or sexual activity

Answer 5

-duration- 30mins to 7 days -exacerbated by: emotional stress, fatigue, noise, or glare -pain characteristics: pressing or tightening; band like tightness, mild to moderate severity, bilateral location, peri-cranial tenderness, poor concentration, NO aggravation by routine physical activity* -associated symptoms: (all must be met)- no vomiting, no more than one of: nausea, photophobia, phonophobia, and no family hx -management: oral analgesics (NSAIDS, acetaminophen), treat anxiety and depression, alternative therapies -prophylaxis (prevention)- TCA's (tricyclic antidepressants)

Answer 6

-without aura- most common -classic migraine (with aura) -migraine in children -basilar artery migraine -ophthalmoplegic migraine- can cause temporary blindness - artery constricts cutting of blood -chronic migraine -atypical migraine -status migrainosus -hemiplegic migraine

Answer 7

-photophobia? -incapacity? does it limit you? -nausea? -if yes, to 2-3 questions -> migraine

Answer 8

-how often do you get severe headaches (without treatment it is difficult to function) -how often do you get other (milder) headaches -how often do you take headache relievers or pain pills (overuse?) -has there been any recent change in your headaches

Answer 9

-questionnaire regarding the past 3 months -how many days did you miss work/school because headaches -how many days was your productivity reduced by half or more bc of headaches -how many days did you not do household work bc of headaches -how many days was your productivity in household work reduced by half or more bc of headaches -how many days did you miss family, social, or leisure activities bc of headaches -how many days did you have a headache -on a scale of 1-10 how painful were these headaches -Grade 1- minimal or infrequent disability 0-5 -Grade 2- mild or infrequent diability 6-10 -Grade 3- moderate disability 11-20 -Grade 4- severe disability >20

Answer 10

-pulsatile quality of headache -one-day duration (4-72 hours) -unilateral location -nausea or vomiting -disabling intensity -92% probability of migraine in pts with at least 4 POUND criteria

Answer 11

-most common subtype of migraine -higher average attack frequency -usually more disabling than migraine with aura -triggers: smell, taste -often have strict menstrual relationship -most prone to accelerate with frequent use of symptomatic medication, resulting in a new headache -medication overuse headache

Answer 12

-at least 5 attacks fulfill B-D -B. headache lasting 4-72 hours (treated or not) -C. headache has >2 of the following: -unilateral location (usually frontotemporal) -moderate or severe pain intensity -aggravation by or causing avoidance of routine activity (walking, climbing stairs) -D. during headache > 1 of the following: -nausea $/or vomiting -photophobia/phonophobia -E. not attributed to another disorder (primary)

Answer 13

-classic migraine -at least 3: -1 or more fully reversible aura symptoms -at least 1 aura symptom develops gradually over >4 mins or 2 or more symptoms occur in succession -no single aura symptom lasts > 60 mins -headache begins within 60 mins of aura onset -H&P and diagnostic tests do not suggest any underlying organic disease

Answer 14

-precede the migraine 5-60mins -simmering spots or stars -zigzag lines that gradually float across your field of vision -loss of vision in one eye -blurred vision -blind spots (scotomas) -objects in your surroundings that appear as if they are shimming in heat -flashes of light -feelings of numbness -tingling -dizziness (vertigo) -difficulty with speech -altered sense of smell or taste -can mimic a stroke!

Answer 15

-attacks may last 1-72 hours -commonly bilateral -occipital (unilateral or bilateral) is rare and calls for diagnostic caution -> many cases are attributable to structural lesions

Answer 16

-headaches are typical of migraine but at least one diagnostic criterion is missing -uncommon

Answer 17

-defined as a migraine attack lasting > 72 hours that has been refractory to treatment -constant with no relief -often associated with pernicious nausea, vomiting, dehydration, and despair -oxygen, ergotamine (vasoconstrictor)

Answer 18

-severe headache preceded by visual aura and brain stem signs of ataxia, vertigo, tinnitus, diplopia, nystagmus, dysarthria -level of consciousness and cognition are affected

Answer 19

-familial syndrome with hemiplegia and alteration in level of consciousness varying from confusion to coma

Answer 20

-associated with acute attacks of third cranial nerve palsy with dilated pupil and unilateral eye pain

Answer 21

-migraine like or tension type like headache on greater than or equal to 15 days/month for >3 months that fulfill criteria B and C -B. Occurring in a pt who has had at least 5 attacks fulfilling criteria for migraine without aura and/or criteria for migraine with aura -C. on greater than of equal to 8 days/month for > 3 months -criteria C and D for 1.1 Migraine without aura -criteria B and C for 1.2 Migraine with aura -believed by the patient to be migraine at onset and relieved by a triptan or ergot derivative -D. not better accounted for by another diagnosis

Answer 22

-A. headache attack fulfilling criteria B and C -B. in a pt with migraine without aura and/or migraine with aura, and typical of previous attacks except for its duration and severity -C. both of the follow characteristics: -unremitting for >72 hours -pain and/or associated symptoms are debilitating -D. not better accounted for by another ICHD-3 diagnosis

Answer 23

-rapid and consistent freedom from pain and associated symptoms, especially the most bothersome symptoms, without recurrence -restored ability to function -minimal need for repeat dosing or rescue medications -optimal self care and reduced subsequent use of resources (ER, dx imaging, clinician and ambulatory infusion center visits) -minimal or no adverse events -cost considerations

Answer 24

-lifestyle modification and education -identify migraine symptomatology that allow for intervention as early as possible -proper nutrition, regular exercise, adequate hydration, proper sleep, stress management, and maintaining a migraine diary -instruct in the proper use of their medications- duration, CI, AE -mild to moderate attacks -moderate to severe attacks -rescue/abortive treatment -non pharmacologic- relaxation, thermal biofeedback, acupuncture -pharmacologic- triptans -neuromodulation -prophylactic management- if occurs more frequently than 2-3 times a month or debilitating -> associated with attacks -frequency, intensity, variants, patient preference, lowest effective dose, adequate trial, long acting preparations

Answer 25

-start medication immediately -Tylenol, ibuprofen -can prevent / abort -earlier the better -educate patient

Answer 26

-simple analgesic (aspirin, acetaminophen, ibuprofen, naproxen) -limit to 15 days or less per month, and combination analgesics should be limited to no more than 10 days per month

Answer 27

-cafergot- combination of ergotamine tartrate and caffeine -1 or 2 tablets are taken at the onset of headache or warning symptoms, followed by 1 tablet every 30 minutes (if needed) -up to 6 tablets per attacked (per 24 hours)* -no more than 10 days per month* -suppository, intravenously or subcutaneously or intramuscularly -contraindications: pregnancy*, cardiovascular disease or its risk factors*, pts taking potent CYP 3A4 inhibitors -constricts the blood vessels -> affects fetus, coronary artery disease

Answer 28

-triptans -5-HT 1b/1d receptor agonists -at least 7 different medications

Answer 29

-subcutaneously by an auto injection -may repeat once after 2 hours if needed -nasal and oral preparations -zolmitriptan is available in oral and nasal formulations (if pt is vomiting) -side effects- nausea and vomiting -contraindications- pregnancy, pts with hemiplegic or basilar migraines, hx of stroke or TIA, uncontrolled hypertension, pts with coronary or peripheral vascular disease and prinzmetal angina -pts with controlled hypertension -> triptans commonly used safely although caution is advised

Answer 30

-ubrogepant (ubrelvy)- Calcitonin gene–related peptide antagonists -lasmiditan (reyvow)- lacks vasoconstrictive properties that other triptans have -> good for pts with cardiovascular risks -rimegepant (nurtec OTD)- Calcitonin gene–related peptide antagonists -prochlorperazine- sedative, rectally, IV, IM -metoclopramide- antiemetic, IV -chlorpromazine- sedative, antiemetic

Answer 31

-if migraine headache occur more frequently than 2 or 3 times a month or significantly disability is associated with attacks -avoidance of triggers and maintenance of homeostasis with regular sleep, meals, and hydration -headache diary

Answer 32

-amitriptyline: more effective, weight gain, dizziness, constipation, improves insomnia -can be addictive -SSRIs

Answer 33

-beta blockers (propranolol) -ACE and ARBs (lisinopril, candesartan)

Answer 34

-topiramate -valproate -gabapentin -cheaper options

Answer 35

-individualized choice of medication will depend on comorbidities, cost, patient preference (route, frequency) -trial and error of medications -length of use -tapering and withdrawing medication -in chronic migraines -> acupuncture, botulinum toxin type A - reduces frequency -neurostimulation techniques- single- pulse transcranial magnetic stimulation, vagus nerve stimulators, and implantable occipital nerve stimulation

Answer 36

-medication overuse -underuse -incorrect medication use- unadvised switches, mixing with OTC meds, delayed use of therapy

Answer 37

-frequency and severity of attacks, presence and degree of temporary disability, profile of associated symptoms such as nausea and vomiting determine Rx -pt hx, response to, tolerance for specific medication must be considered -coexisting conditions (heart disease, pregnancy, uncontrolled hypertension) may limit treatment choices -formal plan of care empowers patients to manage their condition with potential to reduce the number of office and emergency visits

Answer 38

-early intervention -stratified treatment -dose and route- oral, injection, nasal, suppository -medication overuse -rescue treatment- connotes an ineffective outcome from abortive treatment and a need for effective symptom relief with goal of averting an unscheduled visit to a physician office or hospital emergency dept

Answer 39

-clinical dx -pathophysiology- hypothalamic cell activation/triggering the trigeminal autonomic vascular system -typically, men > women -usually beings at age 20-40 -alcohol may trigger attack- stress, glare, or ingestion -frequency- episodic: -between 1 every other day to 8/day -for 1-3 months; followed by remission for months to years -some patients have cluster headache without remission

Answer 40

-duration 15-180 minutes (3 hours untreated) -severe UNILATERAL orbital, supraorbital/periorbital or temporal pain -associated symptoms: (at least one; ipsilateral to pain) -conjunctival injection (swelling of blood vessels in eye), lacrimation -nasal congestion, rhinorrhea -forehead and facial swelling -miosis (pupil constriction) and ptosis (drooping) -eyelid edema

Answer 41

-acute treatment: -Sc or intranasal triptans (sumatriptan- imitrex)* -100% O2* -ergotamine or a combination -intranasal lidocaine? - can numb the area of the trigeminal nerve -NSAIDS -prevention: verapamil, methysergide, lithium, valproate, combination

Answer 42

-A. at least 2 headache episode fulfilling criteria B-D -B. brought on by an occurring only in association with cough, straining and/or other valsalva maneuvre (pressure, ex. going to bathroom) -C. sudden onset (immediate) -D. lasting between 1s and 2h -E. not better accounted for by another ICHD-3 dx -peaks immediately -usually from short lasting efforts

Answer 43

-A. at least 2 headache episodes fulfilling criteria B and C -B. brought on by and occurring only during or after strenuous physical exercise -C. lasting <48 hours -D. not better accounted for by another ICHD- dx -usually from sustained physical exercise -hot weather, high altitude -usually pulsating -indomethacin usually effective

Answer 44

-A. at least 2 episodes of pain in the head and/or neck fulfilling criteria B-D -B. brought on by and occurring only during sexual activity -C. either or both of the following: -increasing in intensity with increasing sexual excitement -abrupt explosive intensity just before or with orgasm -D. lasting from 1 min to 24h with severe intensity and/or up to 72 h with mild intensity -E. not better accounted for by another ICHD-3 dx -first onset -> mandatory to exclude subarachnoid hemorrhage, intra- and extracranial arterial dissection and reversible cerebral vasoconstriction syndrome (RCVS) -multiple explosive headaches during sexual activity -> RCVS until proven otherwise by angiographic study

Answer 45

-A. severe head pain fulfilling criteria B and C -B. abrupt onset, reaching max intensity in < 1 min -C. lasting greater than or equal to 5 mins -D. not better accounted for by another ICHD-3 dx -mandatory to exclude subarachnoid hemorrhage etc. -this is a dx of last resort -> all organic causes have been ruled out -CT first to check for increased ICP (also eye exam to check for papillae edema)-> lumbar puncture -if you do a lumbar puncture with increase ICP it can cause herniation of the brain -thunderclap is not primary -> prof stated on 9/13/23

Answer 46

-IIH -pseudotumor cerebri -disorder associated with obesity, female gender, occasionally pregnancy -generalized headache -generally present on awakening, worse with recumbency (migraine gets better when you lie down) -improves as the day goes on -often associated with papilledema but can also occur without visual problems -MRI< including an MR venogram -lumbar punction- if safe to do so -treatment: -acetazolamide-> 1st choice -> then topiramate - decreases fluid -CSF removal -shunting- chronic

Answer 47

-visual disturbances; field defects

Answer 48

unformed light flashes

Answer 49

some combination of field defects and luminous hallucinations