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CMT > Primary Headaches > Flashcards

Primary Headaches Flashcards

1
Q

examples of primary headaches

3

A
  • cluster
  • tension
  • migraine
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2
Q

example of secondary headaches

A
  • malignancies
  • aneurysms
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3
Q

Key PMHx questions

8 components

A
  1. age at onset
  2. prodrome/aura/postdrome
  3. frequency, intensity, duration of attack
  4. # of HAs per month
  5. Family Hx
  6. quality, site, radiation of pain
  7. associated sx
  8. recent traumas, current meds
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4
Q

PE components for HAs

6 components

A
  1. BP & pulse
  2. Listen for bruits
  3. palpate the head, neck, shoulder
  4. check temporal/neck arteries
  5. examine spine & neck muscles
  6. full neuro exam
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5
Q

Migraine

most common in who?

gender, age

A
  • women more than men
  • boys more than girls
  • ages 30-39
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6
Q

Migraine

what type of migraines are most common in children

A

abd migraines

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7
Q

Migraine

location

A
  • unilateral
  • retro-orbital
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8
Q

Migraine

characteristics

A
  • episodic (lasts minutes to days)
  • unilateral
  • retro-orbital
  • pulsating
  • can be associated w/ aura
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9
Q

Migraine

pt appearance

A
  • pt prefers to rest in a dark, quiet room
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10
Q

Migraine

duration

A

4 to 72 hrs

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11
Q

Migraine

associated sx

A
  • nausea/vomiting
  • photophobia/phonophobia
  • aura
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12
Q

Migraine

differentiate classic vs common migraine

A
  • classic: w/ aura
  • common: w/out aura
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13
Q

Migraine

common triggers

A
  • stress
  • menstruation
  • fasting/dehydration
  • weather
  • sleep disturbances
  • EtOH/caffeine
  • foods
  • sexual activity
  • bright lights
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14
Q

Migraine

describe the 4 phases of a migraine

A
  1. Prodrome: yawning, euphoria,fatigue, food cravings
  2. Aura: visual, sensory, language, motor
  3. HA: unilateral throbbing, n/v, photophobia, phonophobia
  4. Postdrome: fatigue, euphoria
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15
Q

Migraine

describe the aura

3 components

A
  • photophobia/phonophobia
  • cutaneous allodynia (perception of pain caused by normal activities)
  • causes bright lines, shapes, loss of vision, noises, paresthesia
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16
Q

Migraine

what is scintillating scotoma

A

aura spots that flicker between light and dark

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17
Q

Migraine

dx

A

nothing specific, just testing to r/o other causes

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18
Q

Migraine

dx criteria for migraine w/out aura

5 components

A
  1. at least 5 attacks
  2. HA lasting 4 to 72 hrs
  3. HA is 2+: unilateral, pulsating, mod to severe intensity, aggravated by physical activity/causes rest
  4. during HA causes 1+: n/v OR photophobia/phonophobia
  5. not better accounted for by another dx
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19
Q

Migraine

diagnostic criteria for migraine w/ aura

A
  1. at least 2+ attacks
  2. aura has 1+ of the qualities: visual, sensory, speech/language, motor, brainstem, retinal
  3. aura has 3+ qualities: aura spreads over >5 min, 2+ sx occur in succession, aura sx last 5-60 min, unilateral, accompanied by HA
  4. not better accounted for by another dx
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20
Q

Migraine

Abortive Tx

6

A
  1. Triptans
  2. NSAIDs/Opioids
  3. Erogtamine
  4. Metoclopramide, prochlorperazine, chlorpromazine
  5. Steroids
  6. trigger avoidance
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21
Q

Migraine

Preventive Tx

4

A
  1. topiramate
  2. valproate
  3. propranolol
  4. trigger avoidance
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22
Q

Migraine

tx in pregnancy

3

A
  1. avoid ergotamine, NSAIDs
  2. anti-epileptics shouldn’t be used
  3. Use: reglan & acetaminophen
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23
Q

Migraine

tx in adolescents

4

A
  1. avoid triptans
  2. NSAIDs
  3. Promethazine
  4. Propranolol
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24
Q

Tension

describe HA

5

A
  • mild to mod pain
  • non-throbbing
  • dull, pressure, band, tight hat
  • preicranial muscle tenderness
  • NO associated sx
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25
Q

Tension

how to define based on frequency

3

A
  1. infrequent episodic: < 1 per month
  2. frequent episodic: 1-14 per month
  3. chronic: > 14 per month
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26
Q

Tension

epidemiology (age, gender)

A
  • universal
  • Women more than men slightly
  • kids get these much more often than migrains
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27
Q

Tension

common triggers

5

A
  1. stress
  2. fatigue
  3. eye strain
  4. myalgia
  5. mild viral infections
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28
Q

Tension

dx criteria

A
  • 2+ of the following: bilateral, pressing/tight, mild to mod intensity, not aggravated by routine activity
  • both of the following: no nausea and vomiting, no photophobia or phonophobia
29
Q

Tension

Acute Treatment

7

A
  • NSAIDs, Acetaminophen
  • combo meds (butalbital, APAP, caffeine)
  • migraine meds
  • muscle relaxants
  • opioids
  • non-pharmacologic
30
Q

Tension

Chronic Tx

6

A
  1. NSAID
  2. Amitriptyline
  3. Nortriptyline
  4. Fluoxetine
  5. Muscle Relaxant
  6. Nonpharmacologic (physical therapy, acupuncture, avoidance of triggers)
31
Q

Cluster

Describe

8

A
  1. unilateral
  2. non-pulsatile
  3. EXTEREME, brief clusters of pain
  4. conjunctival injection
  5. facial swelling
  6. lacrimation
  7. rhinorrhea
  8. Horner’s Syndrome
32
Q

Cluster

Epidemiology

5

A
  • rare
  • male gender
  • 20-40 y/o
  • genetics
  • smoking
33
Q

Cluster

describe Horner’s syndrome

A
  1. miosis (constricted pupil)
  2. ptosis (droopy eyelid)
  3. anhidrosis (absence of sweating on the face)
  4. enopthalmos (sinking of eye into bony cavity)
34
Q

Cluster

diagnostic criteria

4 components

A
  • at least 5 criteria
  • attacks characterized by severe unilateral orbital, supraorbital, and/or temporal pain lasting 15 to 180 min
  • at least one sx: conjunctival injection/lacrimation, nasal congestion/rhinorrhea, eyelid edema, forehead/facial sweating, miosis/ptosis, sense of agitation or restlessness
  • frequency is 1 every other day, up to 8 per day
35
Q

Cluster

tx for acute attacks

A
  • high flow oxygen
  • SubQ sumatriptan if no response
  • intranasal lidocaine
36
Q

Cluster

Preventive sx

A
  • verapamil and/or steroids
  • home O2
  • avoidance of triggers
37
Q

Red Flags

6

A
  • Onset (sudden, trauma, exertion)
  • sx: altered mental status, seizure, fever, neurologic sx, visual changes
  • meds (anti-coags/abx use/immunosuppressants)
  • PMH: no prior hx, change in HA quality
  • Associated sx (pregnancy, lupus, Bechet’s, vasculitis, sarcoidosis, cancer)
  • PE (neck stiffness, appilledema, focal neurologic signs)
38
Q

Giant Cell Arteritis

pathophys

A
  • inflammation of vessels which can lead to occlusion
39
Q

Giant Cell Arteritis

sx

6

A
  • HA
  • scalp tenderness
  • temporal pain
  • jaw claudication
  • fever
  • amaurosis fugax (temporary loss of vision)
40
Q

Giant Cell Arteritis

dx

A
  • ESR > 50
  • Biopsy
41
Q

Giant Cell Arteritis

tx

A
  • prednisone IV or PO high dose
  • immunosuppressive meds
42
Q

Giant Cell Arteritis

describe associated HA

A
  • throbbing/continuous
  • focal tenderness w/ hair combing, wearing hat
43
Q

Giant Cell Arteritis

describe jaw claudication

A
  • fatigue or discomfort of the jaw muscles
  • result of ischemia of maxillary artery supplying masseter muscles
44
Q

Giant Cell Arteritis

vision sx

A
  • transient or intermittent vision blurring/loss
  • only reversible if steroid treatment began ASAP
45
Q

Giant Cell Arteritis

what is polymyalgia rheumatica?

A

pain and stiffness of shoulder/hip girdle

46
Q

Cervical Artery Dissection

involves which arteries?

A

carotid
vestibular

47
Q

Cervical Artery Dissection

pathophys

A
  • separation of layers of the vessel
48
Q

Cervical Artery Dissection

sx

3

A
  • progressive HA
  • Neck pain
  • ischemic changes
49
Q

Cervical Artery Dissection

dx

2

A
  • CTA
  • MRA
50
Q

Cervical Artery Dissection

tx

A
  • anti-coags
51
Q

Migraine Variants

describe hemiplegic migraines

A

unilateral weakness w/ migrain aura attack

52
Q

Migraine Variants

describe abdominal migraines

A
  • same triggers as migraines
  • abd pain is primary complaint (common in kids)
53
Q

Migraine Variants

describe vestibular migraines

A
  • vertigo associated w/ HA
54
Q

Migraine Variants

describe ocular migraine

A

transient vision loss

55
Q

Occipital Neuralgia

pathophys

A

entrapment of occipital nerve by scalp/nerve muscle

56
Q

Occipital Neuralgia

sx

2

A
  • brief episodes of pain (electric like) in occipital nerve distribution
  • allodynia (can lead to occipital constant HA)
57
Q

Occipital Neuralgia

dx

A

clinical, consider CT/MRI

58
Q

Occipital Neuralgia

tx

3

A
  • occipital nerve block
  • carbamazepine
  • gabapentin
59
Q

Venous Sinus Thrombosis

pathophys

A
  • DVT of brain
  • iscemic changes, disrupts BBB
60
Q

Venous Sinus Thrombosis

sx

4

A
  • HA
  • n/v
  • seizure
  • drowsiness
61
Q

Venous Sinus Thrombosis

dx

3

A
  • MRV
  • D-dimer
  • Thrombophilia screen
62
Q

Venous Sinus Thrombosis

tx

2

A
  • anti-coags
  • endovascularization
63
Q

Carbon Monoxide Poisoning

pathophys

A
  • CO has very high affinity to hgb
  • replaces O2 in RBC w/ CO
64
Q

Carbon Monoxide Poisoning

sx

A
  • HA
  • ILI
65
Q

Carbon Monoxide Poisoning

dx

A
  • can get pulse CO-oximetry
  • clinical suspicion (i.e: multiple pts coming in w/ same complaint from same home)
66
Q

Carbon Monoxide Poisoning

tx

A

oxygen

67
Q

Intracranial Mass

Sx

4 components

A
  • vary widely due to size/location of mass
  • n/v can be seen
  • tension like HA
  • red flags in hx: fever, neurologic sx, over age 50
68
Q

Intracranial Mass

dx

A
  • MRI over CT
69
Q

Intracranial Mass

tx

A
  • depends on tumor type/status of pt/extent of disease
  • early: glucocorticoids and simple analgesics

CMT (78 decks)

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