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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
# Tension how to define based on frequency | 3
1. infrequent episodic: < 1 per month 2. frequent episodic: 1-14 per month 3. chronic: > 14 per month
26
# Tension epidemiology (age, gender)
* universal * Women more than men slightly * kids get these much more often than migrains
27
# Tension common triggers | 5
1. stress 2. fatigue 3. eye strain 4. myalgia 5. mild viral infections
28
# Tension dx criteria
* 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
# Tension Acute Treatment | 7
* NSAIDs, Acetaminophen * combo meds (butalbital, APAP, caffeine) * migraine meds * muscle relaxants * opioids * non-pharmacologic
30
# Tension Chronic Tx | 6
1. NSAID 2. Amitriptyline 3. Nortriptyline 4. Fluoxetine 5. Muscle Relaxant 6. Nonpharmacologic (physical therapy, acupuncture, avoidance of triggers)
31
# Cluster Describe | 8
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
# Cluster Epidemiology | 5
* rare * male gender * 20-40 y/o * genetics * smoking
33
# Cluster describe Horner's syndrome
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
# Cluster diagnostic criteria | 4 components
* 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
# Cluster tx for acute attacks
* high flow oxygen * SubQ sumatriptan if no response * intranasal lidocaine
36
# Cluster Preventive sx
* verapamil and/or steroids * home O2 * avoidance of triggers
37
Red Flags | 6
* 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
# Giant Cell Arteritis pathophys
* inflammation of vessels which can lead to occlusion
39
# Giant Cell Arteritis sx | 6
* HA * scalp tenderness * temporal pain * jaw claudication * fever * amaurosis fugax (temporary loss of vision)
40
# Giant Cell Arteritis dx
* ESR > 50 * Biopsy
41
# Giant Cell Arteritis tx
* prednisone IV or PO high dose * immunosuppressive meds
42
# Giant Cell Arteritis describe associated HA
* throbbing/continuous * focal tenderness w/ hair combing, wearing hat
43
# Giant Cell Arteritis describe jaw claudication
* fatigue or discomfort of the jaw muscles * result of ischemia of maxillary artery supplying masseter muscles
44
# Giant Cell Arteritis vision sx
* transient or intermittent vision blurring/loss * only reversible if steroid treatment began ASAP
45
# Giant Cell Arteritis what is polymyalgia rheumatica?
pain and stiffness of shoulder/hip girdle
46
# Cervical Artery Dissection involves which arteries?
carotid vestibular
47
# Cervical Artery Dissection pathophys
* separation of layers of the vessel
48
# Cervical Artery Dissection sx | 3
* progressive HA * Neck pain * ischemic changes
49
# Cervical Artery Dissection dx | 2
* CTA * MRA
50
# Cervical Artery Dissection tx
* anti-coags
51
# Migraine Variants describe hemiplegic migraines
unilateral weakness w/ migrain aura attack
52
# Migraine Variants describe abdominal migraines
* same triggers as migraines * abd pain is primary complaint (common in kids)
53
# Migraine Variants describe vestibular migraines
* vertigo associated w/ HA
54
# Migraine Variants describe ocular migraine
transient vision loss
55
# Occipital Neuralgia pathophys
entrapment of occipital nerve by scalp/nerve muscle
56
# Occipital Neuralgia sx | 2
* brief episodes of pain (electric like) in occipital nerve distribution * allodynia (can lead to occipital constant HA)
57
# Occipital Neuralgia dx
clinical, consider CT/MRI
58
# Occipital Neuralgia tx | 3
* occipital nerve block * carbamazepine * gabapentin
59
# Venous Sinus Thrombosis pathophys
* DVT of brain * iscemic changes, disrupts BBB
60
# Venous Sinus Thrombosis sx | 4
* HA * n/v * seizure * drowsiness
61
# Venous Sinus Thrombosis dx | 3
* MRV * D-dimer * Thrombophilia screen
62
# Venous Sinus Thrombosis tx | 2
* anti-coags * endovascularization
63
# Carbon Monoxide Poisoning pathophys
* CO has very high affinity to hgb * replaces O2 in RBC w/ CO
64
# Carbon Monoxide Poisoning sx
* HA * ILI
65
# Carbon Monoxide Poisoning dx
* can get pulse CO-oximetry * clinical suspicion (i.e: multiple pts coming in w/ same complaint from same home)
66
# Carbon Monoxide Poisoning tx
oxygen
67
# Intracranial Mass Sx | 4 components
* 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
# Intracranial Mass dx
* MRI over CT
69
# Intracranial Mass tx
* depends on tumor type/status of pt/extent of disease * early: glucocorticoids and simple analgesics

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