Wednesday, 8-24-Headache-Hon Flashcards
Headaches that are a sign of organic disease
Secondary HA
What sorts of triggers are associated with headaches?
- hormones (menstrual cycle, OC’s, HRT)
- diet
- stress
- environmental changes
- sensory stimuli
List some signs which may indicate HA of pathological origin (secondary HA):
- “Worst” HA
- Onset of HA after age 50
- Atypical HA for pt
- HA w/ fever
- Abrupt onset (max intensity in seconds to minutes)
- Subacute HA w/ progressive worsening over time
- Drowsiness, confusion, memory impairment
- Weakness, ataxia, loss of coordination
- Paresthesias/sensory loss/paralysis
- Abnormal medical or neurological exam
What sort of diagnostic evaluations can be done for headaches?
- Lab testing
- Neurodiagnostic tests
- Other: Sedimentation rate, TSH, CBC, glucose
- CT, MRI/MRA, EEG, LP, arteriogram
- Dental, ENT, allergy evaluation
-As a general rule, many believe that any person with HA should have a 1-time, thorough neuroimaging study (CT head with and w/o contrast or MRI of head
What is the intensity of the common migraine?
Moderate to severe
What is the typical age of onset of common migraines? Gender ratio?
Late teens to early 20’s; prevalence peaks between 35-40 years
F:M=3:1
What is the frequency and duration of common migraines? Location?
Frequency: 1-4 attacks per month (occurs infrequently)
Duration: 4-72 hrs, usually 12-24 hrs
Location: UNILATERAL or bilateral
How are common migraines described? Prodrome? What types of behavior are displayed?
Description: throbbing/sharp/pressure
Prodrome: mood changes, myalgias, food cravings, sluggishness, excessive yawning
Behavior: Retreat to dark, quiet room
Is there typically aura with the common migraine?
No: 80-90% of migraine sufferers do not experience an aura
What are the most common associated symptoms with a common migraine?
- Nausea (90%)
- Vomiting (33%)
- Photophobia
- Phonophobia
Describe a classic migraine:
-Aura: usually lasts 15-30 minutes, but sometimes longer. Commonly have visual symptoms (i.e., scintillations, scotoma-often hemianopic) but can be anything
Describe the intensity of a tension-type HA and the type of disability:
Intensity: mild to moderate
Disability: may inhibit, but DOES NOT PROHIBIT DAILY ACTIVITIES
Describe the disability associated with a common migraine:
Inhibits or prohibits daily activities; pain aggravated by activity
What is the general age of onset and gender ratio associated with tension-type HA?
Age of onset: variable; generally peak incidence 20-40 yrs
F:M=3:2
What is the frequency for episodic type vs chronic type for tension-type HA?
Episodic type: 15 days/month
What is the duration for episodic type vs chronic type of tension-type HA?
Episodic type: several hours
Chronic type: all day, waxing and waning
What is the location of tension-type HA? Description? Prodrome or Aura?
Location: BIFRONTAL, BIOCCIPITAL, neck, shoulders, band-like
Description: DULL, ACHING, SQUEEZING, PRESSURE
NO PRODROME OR AURA
Behavior generally not affected
Describe the intensity of a Cluster HA as well as the disability associated with the Cluster HA:
Intensity: SEVERE, EXCRUCIATING
Disability: Prohibits daily activities
What is the age of onset of cluster HA? Gender ratio? Its recent association?
Age of onset: 20’s-50’s
F:M=1:6
Recent association with obstructive sleep apnea –> can put on a CPAP to relieve the HAs
Describe the monthly frequency of cluster HAs in episodic type vs chronic type:
Episodic type: 1 or more attacks/day for 6-8 weeks (MOST COMMON)
Chronic type: several attacks per week without remission (LESS COMMON)
What is the duration of a cluster HA? Location? Description?
Duration: 30 mins-2 hrs
Location: 100% UNILATERAL; GENERALLY ORBITOTEMPORAL
Description: Nonthrobbing, excruciating, sharp, boring, penetrating
Describe prodrome of cluster HA, if there is aura, and behavior associated with the type of HA:
Prodrome: may include brief mild burning in ipsilateral inner canthus or internal nares
No aura
Behavior: FRENETIC, PACING, ROCKING
What are some associated symptoms of a cluster HA?
Ipsilateral ptosis, miosis, conjunctival injection, lacrimation, stuffed or runny nose
What are some hormonally-related HA triggers?
Menses, ovulation, HRT, OC’s
What are some diet-related HA triggers?
Alcohol (esp beer and red wine), chocolate, aged cheeses, MSG, aspartame, caffeine, nuts, nitrates/nitrites, citrus fruits, others
What are some environmental changes associated with HA triggers?
Weather, seasons, travel, altitude, sleep pattern, diet, skipping meals
What are some stress-related HA triggers?
Let down periods, times of intense activity, major life change/stress
What are some sensory stimuli related to HA triggers?
Bright or flickering lights, odors
What are contraindications to triptan usage?
Documented or strong risk factors for ischemic heart disease
Cerebrovascular, cardiovascular, or peripheral vascular diseases
Raynauds syndrome
Uncontrolled HTN
Hemiplegic or basilar migraine
Severe renal or hepatic impairments
Use within 24 hrs of tx with ergotamines, MAOI’s, or other 5-HT1 agonists
A migraine (with or without aura), tension type, cluster HA, post-traumatic HA, drug rebound HA are classified as these types of headache?
Primary HA (benign HA disorders)
What are some preventative measures for migraines?
- Antidepressants (TCAs, SSRIs, MAOIs)
- Beta-blockers (propanolol)
- Ca channel blockers (verapamil)
- anticonvulsants (valproate, gabapentin, topiramate, tigabine)
- ergot alkaloids (ergotomine + phenobarbital)
- NSAIDs(ASA, naproxen)
- Muscle relaxants (Zanaflex)
- Methysergide (sansert)
What are some nonprescription tx suggestions for migraines?
- exercise
- quit smoking
- HA education
- Riboflavin (400 mg daily)
- Mg (325 mg daily for menstrual migraine)
- Biofeedback/relaxation/stress management
What can you use for acute tx of Tension HA?
- OTC analgesics
- NSAIDs (ibuprofen, naproxen)
- Opioids (codeine, hydrocodone)
- Midrin
What can you use as preventative tx for Tension HA?
- antidepressants (TCAs, SSRIs, MAOIs)
- Muscle relaxants (tizanidine)
- anticonvulsants (valproate and gabapentin)
- BOTOX
- Ergot alkaloids (DHE sometimes used to break cycle of chronic daily HA
What can you use for the acute tx of a Cluster HA?
- DHE 1 mg IM or Ergotamine 2 mg SL
- Lidocaine 4%-1 ml intranasal
- Narcotics (meperidine, morphine)
- Oxygen 100% 8L/min by mask
- Sumatriptan 6 mg SQ
- Zolmitriptan nasal spray
What is preventative tx for Cluster HA?
- Ca channel blocker (Verapamil)
- Anticonvulsant (valproate)
- Lithium
- Indomethacin
- Prednisone x 10-14 days
- Capsaicin 0.025% intranasal tid x 1 wk
- Ergotamine tartrate
