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20 Cards in this Set
- Front
- Back
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Medical conditions that place a patient at higher risk for having secondary headaches (4).
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HIV
malignancy severe hypertension anticoagulation |
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Mnemonic for red flags that suggest non-primary headache.
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SNOOP
S - Systemic signs: fever, weight loss N - Neurological S/Sx: altered consciousness, nuchal rigidity, abnormal neuro exam. O - Onset. Sudden or precipitated by coughing, exertion, sexual activity. O - Older onset age: >50 or <5. P - Previous headache history: new headache or change in features in adults >30 is worrisome. |
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Pain quality in primary headaches.
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Tension: nonpulsatile, tight, pressing.
Migraine: Pulsating. Cluster: steady, intense, burning. |
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Location of pain in primary headaches.
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Tension: Usually bilateral.
Migraine: Usually unilateral. Cluster: Unilateral behind one eye. |
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Typical duration of cluster headaches.
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30-45 minutes.
Upper limit is 3 hours. |
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A family history of migraines is found in what percentage of patients with migraines?
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70-90%
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Gender distribution of primary headaches.
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Migraines and tension headaches are more prevalent in females; cluster headaches in males.
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Would the NP expect a patient with cluster headaches to report a positive family history of the same?
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Possible. It is present in abou 20%.
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What is more common: migraine with or without aura?
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Migraine without aura - 80% of migraines.
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What are some potential migraine aura symptoms?
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dread/anxiety
GI upset fatigue excitement/nervousness visual disturbances olfactory disturbances |
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What type of headache is aggravated by normal activity?
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Migraine.
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About n/v, photo/phonophobia in headache.
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The presence of >1 of photophobia, phonophobia, and nausea suggests migraine headache.
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Timing of cluster headaches.
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Typical timing is about 1 hour into sleep ("alarm clock headache"), and occurring in clusters at specific times of the year.
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Other S/Sx found in cluster headache:
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Lacrimation
conjunctival injection ipsilateral nasal stuffiness |
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About lifestyle modifications in primary headache management.
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This is a highly effective and underused approach. Suggestions:
Avoid triggers Regular exercise Good posture Minimize glare |
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Considerations of optimizing migraine headache management in patients with severe nausea and/or vomiting as part of the headache presentation.
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SQ self-injectable sumatriptan, nasal sumatriptan or dihydroergotamine, or suppositories are the best option.
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Optimization of migraine therapy in patients with no aura and severe symptoms.
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A medication with short onset ie. SQ or intranasal triptans or ergots should be used.
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Indications for migraine controller therapy:
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Frequent use of any abortive therapy (>3 times/week).
Frequent disabling headaches (>2 - 3 days/month). Poor relief from abortive therapy. |
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During what time of day is headache from increased ICP worst?
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Morning.
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What analgesic is associated with the most rebound headache risk?
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Acetaminophen
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