test 2 - headaches Flashcards
less than __% of all brain tumors have headache as a significant presenting complaint
5
primary headache vs secondary
primary - no specific organic cause
secondary - caused by underlying organic disease
headache red flags
diplopia
loss of vision in single eye
stiff neck
unilateral weakness or paresthesia
ataxia
sudden and severe onsets tend to be
secondary headaches
think vascular: subarachnoid hem, acute ischemia, acute hemorrhagic stroke
if you have a neuro def then headache comes upon… headache usually
will go away
if you have a headache and then a neuro appears in exam…
stroke on the way
what is the most common cause of severe recurrent headaches
migraine
key symptoms of a migraine
vascular headache
frontal-temporal most common
unilateral (how it starts)
severe
pulsatile/throbbing
last hours to days
nausea+vomiting common
few days prior to or at the onset of their period
reduction in pain after menopause
may change with preg. / childbirth
most common: decrease in freq and intensity in mid-life, picks up after age 65
menstrual migraine
headache induced by foods that contain
tyramine
nitrates
migraine: provacative
usually visual: fortification spectra, scotoma etc
may be nonvisual: vasomotor, change in mood, numbness
precede the HA by 10-30 mins
evolve slowly over 5-10, fade as HA starts
prodrome (ora)
abdominal migraine most commonly seen in
childhood migraine
basilar migraine
looks like a TIA: unilateral subjective paresis
subjective paresthesia/numbness “brainstem signs”
vasopastic migraine
worry about future stroke
prodrome without HA - typical or nontypical
HA without prodome - common or not common
prodrome without HA - not common
HA without prodrome - common
vestibular migraine has this affect
vertigo
what is the neurovascular theory of “prodrome”
uncontrolled synapses in the brain
sucks up all the O2
what is a seizure variant
wave of depolarization causes aura, resultant vasodilation causes HA
medical Rx of headaches
vasoconstrictions
anti-seizure meds
analgesics: dont do much, but opiates are frequently tried
hospital for status migrainous: continuous HA for 24+ hours
non-med Rx
cold on heck/neck
warm hands and feet
when is the best time for acute care
prodrome
hortons headache, histamine cephalgia, hortons cephalgia, alarm clock HA
rapid onset
strong lacrimation, runny nose
eyes bloodshot
“acid poured in the nose or eye” ache
male 10:1
cluster headache
HA lasts from 10 mins to 2 hours
typically wakes pt from sleep
most common type of headache
tension HA
anxiety/depression
tight band around my head, head is in a vise
suboccipital to frontal - tight
tension HA
show some positive findings on a detailed exam of the cervical spine
cervicogenic HA
rebound HA are most commonly from
caffeine/stims
ergot
analgesics
narcotics
pain is transient, but leaves an ache behind
attacks may occur once or twice per day, up to once every minute or two
mouth-ear zone 70%
nose orbit zone 30%
trigeminal neuralgia
inflammatory HA
central retinal artery - blindness
needs ROIDS asap
temporal arteritis
typically non-specific headache, very similar to migraine
simultaneous onset of vertigo, nausea, and headache may be a clue
aneurism of vessels in the subarachnoid space
subarachnoid hemorrhage
whip lash
irritation of greater occipital nerve
physical pressure on the nerve or its distribution usually PPt or increases sympt
occipital neuralgia
most common post trauma
200/120 mmHg +
worse in early AM while in bed
dull, throbbing, diffuse, aching
hypertension HA
increased intercranial pressure
waxes and wans, but never goes away
changes with body position, WORSE WHEN LYING DOWN
intercranial mass
pain in centered over the affected sinus
increases with flexion, pressure, pounding etc
thickening of the mucosa
sinusitis
same signs and sympt as subarachnoid hemorrhage with
FEVER
meningitis/encephalitis
obese women of childbearing age
elevated intracranial pressure and most important neurlogical manifestation is papilledema
may lead to progressive optic atrophy and blindess
pseudo tumor cerebri
