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Flashcards in Headaches and Treatment Deck (89)
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1

Definition of Headache

Pain anywhere in the region of the head or neck

2

Causes of Headaches

Sleep deprivation
Stress
Effects of medication/drugs
Infections

3

Primary Headaches

Migraines
Tension-type
Cluster

4

Secondary Headaches

Trauma (subdural, epidural)
Subarachnoid hemorrhage
Meningitis
Brain tumor
Temporal arteritis

5

Pathophysiology Migraine

Headache results from dilation of blood vessels innervated by the trigeminal nerve caused by release of neuropeptides from parasympathetic nerve fibers

6

Population affected

Women > men
Ages 30-39

7

Precipitating and exacerbating factors

Emotional stress
Hormones in women
Not eating
Weather
Sleep disturbances

8

4 Phases of a Migraine

Migraine prodrome
Migraine with aura
Migraine headache
Migraine postdrome

9

Symptoms of Migraine Prodrome

Euphoria
Depression
Irritability

10

Symptoms of Migraine with Aura

Positive- flashing lights, ringing in ears, music, burning pain, jerking/repetitive movement of muscles
Negative- loss of vision, hearing or feeling; inability to move a part of the body

11

Migraine Headache

Throbbing or pulsatile quality pain
N/V
Photophobia
Phonophobia

12

Migraine Postdrome

Drained/exhausted
Mild elation
Euphoria

13

Migraine Subtypes

Migraine with brainstem aura
Hemiplegic migraine
Retinal migraine
Vestibular migraine
Menstrual migraine

14

Migraine with Brainstem Aura

Uncommon
Female > Male
Ages 7-20
Symptoms: vertigo, dysarthria, tinnitus, diplopia, ataxia, decreased LOC
Need 2+ symptoms

15

Hemiplegic Migraine

Unilateral motor weakness
Manifestations: severe HA, scintillating scotoma, visual field defect, numbness, parathesia, aphasia, fever, lethargy, coma, seizures

16

Retinal Migraine

Repeated attacks of monocular scotomata or blindness lasting

17

Vestibular Migraine

Episodic vertigo with hx of migraines
Exclude brainstem disease

18

Menstrual Migraine

Occur before and throughout menstruation

19

Red Flags for Migraines

"Worst or first" headache
Significant change in severity, frequency, or pattern
New or unexplained neurologic symptoms
HA always same side
New onset HA after age 50
HA not responding to treatment
New onset HA with HIV/cancer

20

Red Flag Sign/Symptoms for Migraines

Stiff neck
Fever
Papilledema
Cognitive impairment
Personality change

21

Diagnostic Criteria for Migraine without Aura

At least 5 attacks
HA attacks 4-72 hours
HA with 2 of the following- unilateral location, pulsating quality, moderate/severe pain intensity, avoidance of routine physical activity
N/V, photophobia, phonophobia occur during HA

22

Diagnostic Criteria for Migraine with Aura

At least 2 attacks
1+ reversible aura symptoms: visual, sensory, speech, motor
2+ characteristics: one aura symptom >5 minutes and/or 2+ symptoms in succession, aura symptom 5-60 minutes, one aura symptom unilateral, aura accompanied by HA within 60 minutes

23

Treatment of Migraines

1st- NSAIDs or aspirin
2nd- Triptans
3rd- Triptans + NSAID
Opiods/Barbituates

24

Define Tension-Type Headaches

Bilateral non-throbbing headache without other associated features

25

Pathophysiology of Tension-Type Headaches

Peripheral activation or sensitization of myofacial nociceptors that migrate through pain pathways in the CNS

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Clinical Features of Tension-Type Headache

Mild-moderate intensity
Dull, band-like, tight cap, pressure
Pericranial muscle tenderness
Poor concentration

27

Precipitating Factors of Tension-Type Headache

Stress/mental tension
Fatigue
Noise

28

Treatment of Tension-Type Headache

Techniques for relaxation
1st- ASA, Tylenol, Ibuprofen, Naproxen
2nd- 1st line with caffeine
3rd- Butalbital
Parenteral- Toradol

29

Cluster Headache

Characterized by recurrent severe HA on one side of the head

30

Eye Symptoms of Cluster HA

Watering of the eye
Nasal congestion
Swelling of the eye
Rhinorrhea
Lacrimation