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52 Cards in this Set
- Front
- Back
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Headache
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most common reason pts. seek medical attention
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headache causes (number)
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over 100
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tension-type headache
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88% women and 69% men
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Headache, past medical history
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trauma and prior headaches
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headache triggers
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menstruation, exertion, foods
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headache medical history and effects
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including non-pharmacologic or OTC treatment
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headache social history
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physical activity, occupation/work hours, caffeine, drugs, diet
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head neck examination, particularly
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carotid arteries, paranasal sinuses, cervical spine, and fundi
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neurological examination
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mental status, cranial nerves, and spinal tracts
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blood test
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electrolytes, serun urea nitrogen, creatinine, liver enzymes, thyrotropin, ESR and HIV testing
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neuroimaging
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CT, or MRI
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neuroimaging indicated in
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worsening headache, focal signs/sx, onset with exertion, cough, or sexual activity, orbital bruit, onset after 40
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Consult with
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neruologis, ophthalmologist, otolaryngologist, rheumatologist, physiatrist, and psychiatrist
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other diagnostic tests
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sinus radiography, ocular tonometry, cervial spine imaging, lumbar puncture, and cerebral angiography
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primary headache
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not caused by another dz
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secondary headache
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caused by associated dz, minor to life threatening
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as many as 90% of headaches
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migraine, tension-type, and cluster
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most common headache syndromes
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frequently present with characteristic symptoms, may be considerable sympton overlap
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Migraine, unilateal
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60 to 70%
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migraine bifrontal or global
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30%
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Migraine characteristics
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gradual in onset, pulsating, aggravated by routine physical activity
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Migraine pt appearance
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rest in dark quiet room
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Migraine duration
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4-72 hrs.
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Migraine associated symptoms
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nausea, vomitinf, photo/phonophobia
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Tension location
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bilateral
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tension characteristics
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pressure or tightness, waxes and wanes
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tension pt. appearance
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remain active or need to rest
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tension duration
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variable
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tension associated symptoms
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none
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cluster location
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always unilateral, usually begins around eye or temple
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cluster characteristics
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pain begins quickly, peak within minutes, deep, continuous, excruciation, and explosive
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cluster pt appearance
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remains active
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cluster duration
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30 minutes to 3 hrs
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cluster associated symptoms
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ipsilateral lacrimations and redness of eye, rhinorrhea, pallor, sweating, horner's, focal neurological sx rare, sensitivity to alcohol
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Migraine tx
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educate, triptans, DHE, ergotamine (severe or poorly to NSAIDs), nonoral for vomiting, self medication rescue, and guard medication overuse headache
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Tension tx
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APAP, NSAIDs, avoid ergotamine, caffeine, butalbital, and codeine (rebound headache)
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Tension tx success
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nonpharm and pharm means incorporation = 90%
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Somatic dysfuntion common causes of headaches
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OA, C2, C3
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RED FLAGS
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certain aspcets of presentation that signal danger or a serious problem
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REF FLAGS (types)
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new or sudden onset, change in pattern, effor induces, positional, onset in middle age/later, recent trauma, illness, fever, neck stifness, changes in personality/behavior, neurological findings
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subarachnoid hemorrhage, most common
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an aneurysm, a ballooning of the weakened wall of an artery inside the head
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Ruptured intracranial aneurysm
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"the worst headache of their life"
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carotid dissection
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impingement of artery, rapid onset with exercise, esp. with trauma
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Hydrocephalus, communicating
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impaired cerebrospinal fluid resorption in the absence of any CSF-flow obstruction
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Hydrocephalus, non-communicating
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a blockage in CSF drainage
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Nasal sinuses
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aerated cells in the bones of the skull
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Nasal sinus lining
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ciliated epithelium
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Nasal sinuses subject to.
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same irritate as upper respiratory mucosa
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TMJ dysfunction evaluation
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malocclustion, teeth grinding, and muscular imbalance
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TMJ dysfunction, common signs
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clicking/popping, pre-auricular pain, limited movement, tenderness
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Average TMJ opening
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40mm
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Headache diary
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for pt to keep track of headaches
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