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21 Cards in this Set

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A progressive headache disorder, new onset of headache in middle or later life, headaches that disturb sleep or are related to exertion, and headaches that are associated with neurologic symptoms or a focal neurologic deficit usually require What imaging
MRI
or
CT

to exclude mass lesion
What to do? Acute onset of "worst headache in my life." Increasing headache unresponsive to simple measures. • History of trauma, hypertension, fever, visual changes. • Presence of neurologic signs or of scalp tenderness.
Refer for imaging
Most common type of HA disorder. May complain of: Pericranial tenderness, poor concentration, and other vague nonspecific symptoms, also daily HA's that are often vise like and tight but are not pulsatile.
Tension HA
TX: if simple analgesics not effective, trial of anti migrainous agents. Relaxation techniques include massage, hot bath, biofeedback. Explore underlying cause of possible chronic anxiety.
Tension HA
HA usually pulsatile, pain typically though not always unilateral, Nausea, photophobia, vomiting, phonophobia are common. May have transient neurologic sx
Migraine HA
Build up gradually and last several hours or longer. Other focal disturbances such as aphasia or numbness, clumsiness, dysarthria, disequilibrium, or weakness may occur.
Migraine HA
Visual disturbances in both visual fields
dysarthria,
dysequilibrium,
tinnitus,
perioral and distal paresthesias
sometimes followed by transient loss or
impairment of consciousness or confusion.
Then throbbing HA with nausea and vomiting.
Basilar artery migraine,


an uncommon variant
Lateralized pain - usually around eye accompany by N/V and diplopia due to transient external ophthalmoplegia
Ophthalmoplegic migraine-rare
Ergotamine containing RX with high affinity for serotonin. Rapid when given sub-Q by auto injection.

Avoid in pts with
hemiplegic or basilar migraines,
stroke risk factors,
pregnancy.

Best to combine with naproxen (500mg).
Sumatriptan, + Naproxin 500mg
symptomatic tx for migraine
Rest in quiet dark room and take simple analgesics right away may work for some
Symptomatic tx for migraines
Clonidine,
Cyproheptadine,
Amitriptyline,
Fluoxetine,
Verapamil.
Imipramine,
Propanolol,
Sertraline,
Prophylactic drugs for migraine

CCAF
VIPS
Predominantly affects middle aged men. Usually no family HX. -Episodes of severe unilateral periorbital pain occur daily for weeks
Cluster HA
Accompanied by one or more of the following:
Days that clump together w HA
One eye or focal point on Face
Ipsilateral nasal congestion
Rhinorrhea,
Lacrimation,
Eye redness,
Horner syndrome.
Pts often restless and agitated in attacks.
Cluster HA
In children, Horner's syndrome sometimes leads to heterochromia: a difference in eye color between the two eyes.[2] This happens because a lack of sympathetic stimulation in childhood interferes with melanin pigmentation of the melanocytes in the superficial stroma of the iris.

Horner's syndrome or Horner syndrome is a clinical syndrome caused by damage to the sympathetic nervous system. It is also known by the names Bernard-Horner syndrome or Claude Bernard-Horner syndrome or as oculosympathetic palsy.
Often at night , awaken pt and last 15 min to 3 hours. Spontaneous remission and pt well for several weeks or months before more closely spaced. Bouts can last 4-8 weeks.
Cluster HA
Usually appears within a day or so following injury, may worsen over the ensuing weeks, and then gradually subsides. It is usually a constant dull ache, with superimposed throbbing that may be localized, lateralized, or generalized.
Posttraumatic HA
It is sometimes accompanied by nausea, vomiting, or scintillating scotomas. Headaches occurring more than 1-2 weeks after the inciting event are probably not directly attributable to the head injury.
Posttraumatic HA

A scotoma
(Greek for darkness; plural: "scotomas" or "scotomata") is an area of partial alteration in one's field of vision
Severe head pain caused by
(Straining, sneezing, laughing)
lasting a few minutes.
R/o intracranial lesions

self-limited,
may persist for several years.
unknown why s/s clear completely
after lumbar puncture.
Cough HA
major symptom is headache,
often associated / preceded by
myalgia,
malaise,
anorexia, weight loss,
other nonspecific complaints.

Loss of vision is the most feared manifestation
and occurs quite commonly
Also has locaized temporal Px
Temporal arteritis
worsened by exertion or postural change
may be associated w nausea and vomiting,
but this is true of migraine also.
Progressive headache disorder
or
new onset of headaches in middle or later life
Intracranial mass lesion
Present with chronic pain or with complaints of severe headache unresponsive to medication. Withdrawal of analgesics leads to relief of headache within several months.
Analgesic rebound HA
Dull or throbbing headache and may last for several days. It is aggravated by the erect posture and alleviated by recumbency. Sequelae of a certain procedure
Lumbar puncture HA