Headaches
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- What is the most common pain complaint to a primary care physician?
- Headache
- What are the most common type of recurring headaches?
- Migraines
- What is the most common type of primary headache?
- Tension
- True/False: Tension headaches are more common in women than in men.
- True.
- To be classified as chronic, tension headaches must occur more than how many days in a month?
- 15
- List the criteria by IHS to diagnose tension headache.
-
1. bilateral
2. pressure headache, non-throbbing
3. Mild to moderate intensity
4. No functional impairment
5. No nausea/vomiting, sensitivity to light/noise, or focal neurologic symptoms - True/False: Stress can cause a tension headache.
- False
- What is the best treatment for acute tension headaches?
- NSAIDs
- What is the danger in using narcotics and butalbitols to treat tension headaches?
- headaches are prone to worsen with these meds, can also cause habituation and addiction
- What are some preventative meds for tension headaches?
- TCAs, anticonvulsants such as valproate
- What is the most common headache presented to a doctor and why?
- Migraine b/c of severity
- Women are ___ time more likely to suffer from a migraine than men.
- three
- What is the most common misdiagnosis for migraine and why?
-
Sinus headache b/c
1. Pain is found over sinuses.
2. Migraine can cause congestion.
3. Weather changes can trigger migraines.
4. Sinus meds can help migraines.
5. Steriods will make it better. - List the IHS criteria for diagnosing migraines w/o aura.
-
1. Two of the following characteristics: unilateral, pulsating, moderate/severe intensity, worsened by activity.
2. One of the following symptoms: nausea/vomiting, photophobia, phonophobia
3. Have to have at least 5 - What distinguishes a migraine w/ aura?
- reversible neurological deficit lasting less than an hour preceding the headache
- What is scintillating scotomata? What is it pathogneumonic for?
- zig-zag, C-shaped "thing/graying out of vision" that moves across visual field. Pathogneumonic for migraine w/ aura.
- True/False: Migraines can be associated with menstration.
- True.
- True/False: Most people w/ migraines do not have a family history of migraines.
- False. 90% have a family history.
- What are some common comorbidities associated w/ migraines?
- affective disorders, IBS, fibromyalgia, chronic fatigue syndrome, mitral valve prolapse, epilepsy
- What neurotransmitter is thought to be involved with migraines and causes many of the comorbidities?
- Serotonin
- What are five common triggers of migraines?
- odors, food, alcohol, weather changes, routine changes
- What genes (on which chromosomes) have been related to Familiarl Hemiplegic Migraine?
- 2 calcium channels and a Na/K channel on chromosomes 1 and 19
- Which cranial nerve is a migriane mediated by?
- Trigeminal (V)
- What is a spreading cortical depression?
- wave of intense cortical excitation followed by a wave of cortical suppression beginning in the occipital poles and moving anteriorly.... thought to be a possible cause of migraine
- True/False: Migraine is a vascular problem.
- False, neurogenic process
- Trigeminal afferents along the perimeningeal vessels synapse in which nucleus?
- Trigeminal nucleus caudalis
- The superior salivatory nucleus sends a signal to teh perimeningeal vessels through which ganglion?
- sphenopalatine ganglion
- Which nuclei are involved with the central processin of pain and are thought to be involved in a migraine?
- raphe nuclei
- The nucleus caudalis is located near which structure that is triggers an important symptom of migraines?
- emesis center --- nausea and vomiting
- The superior salivatory nucleus is located near the ______ causing congestion.
- glandular structures of the sinus cavities
- Which two receptors mediate activation of the trigeminal neurons?
- 5HT1b and 5HT1d
- What are three serotonin receptor agonists used in treatment of migraines?
- triptans, ergotamines, dihydroergotamine
- Which are more eficacious: triptans or ergotamines?
- triptans
- What are some preventative treatments for migraines?
- Beta blockers, calcium channel blockers, TCAs, anticonvulsants such as valproatea and topimarate
- Cluster headaches are more common in men or women?
- men (8 times more common)
- How often do cluster headaches occur?
- once a day
- What are cluster headaches commonly called?
- suicide headaches --- very severe pain
- How long do cluster headaches last?
- 30 minutes to 3 hours (distinguishing feature b/c migraines last many hours)
- Are cluster headaches unilateral or bilateral?
- unilateral
- What symptoms are cluster headaches associated w/?
- autonomic signs such as lacrimation, rhinnorrhea, ptosis, scleral injection (redness of eye), ipsilateral to headache
- What are some treatments for cluster headaches?
- oxygen, indomethacin, ergotamines, triptans, steroids
- What are some preventative treatments for cluster headaches?
-
Ca channel blockers (1st line)
lithium - Patients with analgesic rebound headache are usually taking meds for primary headaches greater than ___ days a week
- two
- True/False: Patients with analgesic rebound headaches typically respond well to preventatives.
- False
- What is treatment for analgesic rebound headache?
- Slowly withdraw off of analgesic
- How long should you wait for preventative meds to be effective?
- 2 months
- When should you work up a a headache?
- atypical history, elderly, change in previous headache pattern, focal neurological signs, positional headaches
- What is involved in a headache workup?
- CT (r/o bleed), MRI (structure), LP (SAH or increase CSF pressure)
- What causes pseudotumor cerebri?
- decreased absorption of CSF
- Who is pseudotumor cerebri generally seen in?
- obese young women
- What is the triad of symptoms of pseudotumor cerebri?
- normal CT, headache, papilladema
- Headache in pseudotumor cerebri is increased in the ____ position.
- supine
- What is treatment for pseudotumor cerebri?
- acetazolamid, serial LPs, shunting, weight loss, optic nerve fenestration
- Low pressure headaches usually follow after a _____.
- lumbar puncture
- Low pressure headaches are generally worse when in the ____ position.
- standing
- What is treatmen for low pressure headache?
- bed rest, anti-inflammatories, epidural blood patch, or surgical repair
- What should you always think with a thunderclap headache?
- subarachnoid hemorrhage