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34 Cards in this Set
- Front
- Back
What are the types of primary headaches (benign HA disorders)?
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Migraine (with or without aura)
Tension type Cluster HA Post-traumatic HA Drug rebound HA |
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What are secondary HA's?
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Headaches that are a sign of organic disease
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What should be asked in the headache history?
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How many types of HA's?
Frequency - previous, current, mode of increase (gradual or sudden) |
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What should be asked of the headache pain?
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Intensity
Location Duration Impact of exertion |
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What should be asked about the HA prodrome?
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Changes in energy levels, mood, appetite
Fatigue Muscle aches Aura |
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What are some associated symptoms of HA?
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Nausea
Vomiting Anorexia Photophobia Phonophobia Diarrhea Stuffy/runny nose Watery eyes Ptosis/miosis Dizziness Behavior - retreats to dark room, paces, rocks |
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What are some triggers of HA?
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Hormones - menses, HRT, OC's
Diet - alcohol (beer/red wine), chocolate, aged cheese, MSG, aspartame, caffeine, nuts, nitrates, citrus Stress Environmental changes Sensory stimuli - bright/flickering lights, odors |
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What do you need to know about current and previous medications tried for HA?
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For both prophylactic and abortive therapy
Dosages Effectiveness Side effects |
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What should be included in a good general exam for a HA patient?
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Vital signs - particularly BP/pulse (HTN can cause HA)
Cardiac status Extracranial structures ROM and presence of pain in C-spine |
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What should be included in the neurological exam of a HA patient?
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Neck flexion
Presence of bruits over the head and neck Optic fundi, pupils, visual fields Thorough cranial nerve exam Motor power in limbs Muscle reflexes Plantar responses Sensory exam Coordination Gait |
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What are signs that may indicate HA of pathological origin (secondary HA)?
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"Worst HA"
Onset of HA after age 50 Atypical HA for patient HA with fever Abrupt onset (max intensity in sec to min) Subacute HA with progressive worsening over time Drowsiness, confusion, memory impairment Weakness, ataxia, loss of coordination Paresthesias/sensory loss/paralysis Abnormal medical or neurological exam |
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What is included in the diagnostic evaluation for HA?
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Lab testing (appropriate for variant or atypical forms) - WSR, TSH, CBC, glucose
Neurodiagnostic tests - CT, MRI/MRA, EEG, LP, arteriogram Other - dental, ENT, allergy evaluation |
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T or F: Any patient with a worrisome history or abnormal examination needs an urgent imaging study and perhaps even an LP and possibly arteriogram.
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True
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What is the intensity, disability, age of onset, and gender ratio for a common migraine?
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Intensity: moderate to severe
Disability: inhibits or prohibits daily activities, pain aggravated by activity Age of onset: late teens - early 20s, prevalence peaks between *35-40 years *Gender ration: F:M = 3:1 |
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What is the frequency, duration, location, and description of common migraine?
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Frequency: 1-4 attack per month
Duration: 4-72 hrs, usually 12-24 hrs Location: *unilateral or bilateral *Description: throbbing/sharp/pressure |
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What is the prodrome, postdrome, behavior, and aura for common migraine?
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Pro: Mood changes, myalgias, food cravings, sluggishness, excessive yawning
Post: fatigue, irritability, "fog" *Behavior: retreat to dark, quiet room |
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What are associated symptoms of common migraine?
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Most common: nausea, vomiting, photophobia, phonophobia
Least common: diarrhea, conjunctival injection, stuffy nose, lacrimation, miosis, ptosis |
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What is classic migraine?
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Migraine with aura
Usually lasts 15-30 min, but sometimes longer Commonly visual symptoms (eg scintillations, scotoma - often hemianopic) but can be anything neurological |
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What is the intensity, disability, age of onset, and gender ratio for tension type HA?
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Intensity: mild to moderate
Disability: may inhibit but does not prohibit daily activities Age of onset: variable, peak incidence 20-40 yrs Gender ration: F:M = 3:2 |
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What is the frequency, duration, location, and description of tension-type HA?
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Frequency: episodic type (<15 days/mo) or chronic (>15 days/mo)
Duration: episodic (several hrs) or chronic (all day, waxing and waning) Location: *bifrontal, *bioccipital, neck, shoulders, band-like *Description: dull, aching, squeezing, pressure, no prodrome or aura |
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What are analgesic rebound HAs?
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Taking analgesics every day can train the body that it is going to receive medicine so it makes more pain receptors
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What is the intensity, disability, age of onset, and gender ratio for cluster HA?
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*Intensity: severe, excruciating
Disability: prohibits daily activities Age of onset: 20s to 50s *Gender ratio: F:M = 1:6 (recent association with obstructive sleep apnea) |
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What is the frequency, duration, location, and description of cluster HA?
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Monthly frequency: episodic (1 or more attacks/day for 6-8 wk) or chronic (several attacks/wk w/o remission)
Duration: 30 min - 2 hrs *Location: 100% unilateral, generally orbitotemporal Description: nonthrobbing, excruciating, sharp, boring, penetrating |
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What is the prodrome, aura, behavior, and associated symptoms of cluster HA?
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Prodrome: may include brief mild burning in ipsilateral inner canthus or internal nares
Aura: none *Behavior: frenetic, pacing, rocking *Associated symptoms: ipsilateral ptosis, miosis, conjunctival injection, lacrimation, stuffed/runny nose |
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What is used for acute treatment of migraine?
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OTC analgesics
NSAIDs Isometheptene Butalbital Opioids DHE nasal spray Triptans (5HT1 agonists) - specific for migraine, not just pain |
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What are contraindications to triptan use?
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*Documented or strong risk factors for ischemic heart disease, other CV, cerebrovascular, or peripheral vascular disease, Raynaud's syndrome, uncontrolled HTN, hemiplegic or basilar migraine, use within 24 hr of tx with ergotamines, MAOI's, or other 5HT1 agonists
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What is DHE protocol?
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Metoclopromide or prochloperazine 10 mg IV over 60 sec
Wait 5 min to allow distribution Give DHE .5 mg IV over 60 sec, wait 3-5 min May repear .5 mg IV if no relief, may repeat every 8 hr for short-term use *Same contraindications as triptans Side effects: chest pressure, anxiety, speeding or dissociation of thoughts, nausea |
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What are adjunctive agents for migraines?
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Antiemetic if nausea vomiting major feature (before analgesic meds)
Sedative/hypnotic or major tranquilizer if insomnia major feature Prednisone taper sometimes used to break cycle of prolonged migraine or several wks of frequent migraines |
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What is used for preventative treatment of migraine?
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Antidepressants: TCA's, SSRI's, MAOI's
Beta-blockers CCBs Anticonvulsants: *valproic acid and *topiramate Ergot alkaloids NSAID's Muscle relaxants Methysergide BOTOX injections |
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What are nonprescription treatments of migraine?
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Exercise
Stop smoking HA education Riboflavin Magnesurm Biofeedback/relaxation/stress management |
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What is used for acute treatment of tension HA?
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OTC analgesics
NSAID's Opioids Midrin |
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What is preventive treatment for tension HA?
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Antidepressants: TCA's, SSRI's, MAOI's
Muscle relaxants Anticonvulsants BOTOX injections Ergot alkaloids |
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What is acute treatment for cluster HA?
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DHE 1 mg IM or Ergotamine 2 mg SL
Lidocaine 4% - 1ml intranasal Narcotics Oxygen 100% 8L/min by mask Sumatriptan 6 mg SQ |
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What is preventive treatment for cluster HA?
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CCB
Anticonvulsant Lithium Indomethacin Prednisone x 10-14 days Capsaicin .025% intranasal tid x 1 wk Ergotamine Tartrate |