Types of Headaches Flashcards
TRACTION HEADACHE
what happens?
What are they caused by?
What should you consider?
There are mass lesions in the head that produce pain when the nerves and blood vessels in the area become distended/stretched.
Cancerous tumors, intraparenchymal bleeds (clots), cyst or abscess.
Hydrocephalus
TRACTION HEADACHE
Severity?
Increases with time
Vascular Headache
SINUS headache
“ICE CREAM” headache
unrelieved pressure or infection. Pain on palpation
b/c of rapid cooling
Vascular Headache
FEVER headaches
ANEMIC & ANOXIC headaches
EFFORT or COITAL headache
vasodilation b/c of higher temp
vasodilation 2nd to low pH, lactic acidosis & high CO2
occur b/c of vasodilation 2nd to low pH, lactic acidosis & high CO2
occur following a sudden burst of energy. They can be migraine like, with N&V. Occur more often in males. Post-coital headaches occur more often in males & is related to guilt
Vascular Headache
HYPERTENSIVE headache
HIGH ALTITUDE headache
POST-SEIZURE headache
occurs with a sudden rise in blood pressure or when diastolic surpasses 130mmHg
occurs b/c of cerebral edema & above 10,000 to 12,000 feet elevation
occurs b/c of hyperthermia,
exertion, neuronal irritability, edema & hypoglycemia
Vascular Headache
CVA headache
CAFFEINE headache
NITRATE headache
occurs in only 1/3 of the cases, (where
there is involvement of the larger vessels). Pain is not indicative of the severity of the CVA
like cocaine, b/c stimulant effect
b/c of coronary & cerebro-vascular vasodilation effect
MIGRAINE
How is it characterized?
What’s common about them?
MEN or WOMEN?
by recurrent attacks of headache widely variable in intensity, frequency, & duration
unilateral & are usually associated with anorexia, nausea & vomiting
occurs more in women
MIGRAINE
When do the cases occur?
Rare for 1st time migraines in above 40y olds
Frequency?
90% before age 40 so 25-45y old
With age some arteriosclerosis meaning the vessels aren’t constricting/d
unpredictable
MIGRAINE
What are the initiators?
What is the AURA?
Bright lights, florescent lights (imperceptible flickering)
Tyramine (fermented foods, hard cheese, red wine).
Foods, especially caffeine, MSG, Nitrites (preservative found in bacon, salami), phenylethylamine (found in
chocolate), Alcohol, hunger
Nitrate use, change in prescription.
Menstruation
Fall in barometric pressure
Exhaustive physical, mental or emotional work
Excessive or insufficient sleep
Focal vasoconstriction causes focal ischemia
MIGRAINE
How do you manage a migraine?
3 ways
Prophylactic therapy, aimed at reducing the
fluctuations of serotonin, or the response to it.
(serotonin reuptake inhibitors & monoamine oxidase inhibitors, beta blockers, histamine antagonists)
Abortive therapy, aimed at restoring the
vascular tone.
(reserpin (serotonin like), ergotamine (vasoconstrictor agents))
Analgesics, aimed at pain control.
(tylenol with codeine, demerol, morphine)
What is the presentation of a “classic” migraine?
12% of all headaches
Temporary scintillating scotoma (eye fuzzies)
Homonymous hemianompsia (vision feild loss) - bright jagged lines
Prodromal phase (when) is clearly defined
Aura lasts up to 1 hour (5 to 30 minutes) caused by cortical ischemia as a result of decreased cerebral blood flow
Extremity weakness or paraesthesia
The headache is “throbbing”
May last 4 hour to 72 hours
Nausea & Vomiting
Photophobia, sonophobia & anorexia
No evidence of underlying disease
What is the presentation of a “common” migraine?
80% of all migraines
Aura is unusual
Vague prodrome which is variable
The peripheral signs are more prevalent
The headache is “throbbing”
May last 4 hour to 72 hours
Nausea & Vomiting
Photophobia, sonophobia & anorexia
No evidence of underlying disease
What is the presentation of a “cluster” headache?
There’s NO Aura
2-9% of all migraines
The clinical prodrome is limited
The “clusters” are 1-3 headaches every day for a
few weeks to a few months at a time
The patient’s face is often heavily “chiseled”.
Trigger is not known.
Begin usually at the same times each day, without warning, or aura.
Usually “clusters” around one eye, cheek, temple & forehead. - often reddened and tearing eye
Extremely severe.
Does not throb, instead “steady, boring piercing
pain, not relieved by any maneuver.
These patients don’t lie still in the dark like
migraine patients, they thrash in pain.
After about 30 minutes (10 to 75 minutes), the pain eases & then quickly resolves
