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26 Cards in this Set

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  • Back

"Worst HA of life" like being "struck accross head w/ a baseball bat" suggests....

subarachnoid hemorrhage!


Majority of pts w/ HA have normal physical & neurological exam


If an elderly pt w/ a worsening headache, located over left jaw & temporal region & blurry vision, presents w/ palpable, nonpulsatile, tender temporal arteries, what do you suspect?


Temporal (Giant Cell) arteritis

Tx: IV prednisone given promptly!

(dx w elevated ESR & confirmed w. temporal artery biopsy)

Headache w/ papilledema suggests....

Increased intracranial pressure

_________ are recurring HAs that involve the blood vessels, nerves (Trigeminal nerve), & brain chemicals.

MC in females, onset usually in young adulthood


(spasm of cerebral vessels---> dilation of extracranial arteries--> pain)

______ are episodic UNILATERAL HA's, often associated w/ neurologic (photophobia), GI (anorexia, N/V), &/or autonomic changes & auras

*frontotemporal location, dull (mild) or throbbing pain (severe)




Migraines occur MC (80%) W/O an aura (common migraine)


(migraine w/ aura = classic migraine, less common)

Auras last < 60 mins, what is the Mc type?

Scotoma = visual phenomena that precedes the HA (resembles being too close to a camera flash)

Migraine attack + major neurologic dysfunction (hemiplegia, coma, etc) that last longer than the migraine

Complicated migraine

Migraines do not require CT &/or spinal tap for dx UNLESS....

New symptoms

(rule out emergent condition)

Migraine: treatment

(tx when feel onset, can stop from progressing*)

Drugs: NSAIDs/ tylenol, caffeine - mild

Dihydroergotamines, Tryptans, Anti-emetics, TCAs - moderate

Opioids - severe/resistant

Avoid triggers (glaring, flashing lights)

Regular meals & sleep

Minimize environmental stress (relaxation training, meditation, etc)


Cluster HAs are common & associated w/ auras


Cluster HAs are uncommon & not assoc w/ auras

*One of many Trigeminal Autonomic Cephalgias

____________ sudden onset, extremely intense constant HA assoc w/ Horner's like sxs (ptosis, miosis), nasal congestion, conjunctival injection, & increased sweating on ipsilateral side.

*UNILATERAL Retroorbital location (behind eye)

*Reoccurs frequently over several days/ weeks (interspersed w pain free periods)

Cluster Headache

Cluster HA: tx

preventative- beta blockers

abortive- oxygen, DHE, Ergotamines, triptans

(not relieved by sitting in dark)

MOST common type of headache

(& least severe)

Tension Headache

"Vicelike" (pressure-like) BILATERAL headache w/ pain in the neck & upper shoulders, lasts long periods (days)



Dx: Tension Headache

Tx: Anxiety/Depression Evaluation, TCAs (prevention), Massage, acupuncture, IM botulin injection, omm


Stress can cause tension headaches


(craniocervical muscle tension can also cause)

HA + Fever + Neck stiffness

+ Brudzinski's

+ Kernigs

what do you suspecT?


Headache & facial pain that is worse w/ movement

What do you suspect?


Acute Sinusitis

(chronic sinusitis usually NOT accompanied by HA**)

Tx: nasal decongestant

Obese female of childbearing age, experiences HA's & visual disturbances w/ exertion. PE shows papilledema



Dx: Idiopathic Intracranial HTN (benign intracranial HTN, "pseudotumor cerebri"

Tx: Weight loss*, Acetazolamide, CSF shunting (for refractory cases)

_________ mc occurs as a result of CSF leakage through the dural sac following a spina tap

*Pt presents w/ HA that is relieved in the recumbent position


Idiopathic Intracranial HYPOtension

tx: blood patch (stops leakage)


Cranial Neuralgias are long lasting


Neuralgias are very brief (1-2 seconds or less)

________ Neuralgia;

-women, middle age or older

-paroxysmal, excruciation episodes of ipsilateral facial pain (very brief)

-pain exacerbated or triggered by any slight touch to face (touch, movement, drafts, eating)


Trigeminal neuralgia -->

(aka Tic Douloureux)

caused by vascular compression of the trigeminal nerve root, usually the unilateral 2nd or 3rd division

tx: carbamazepine, anticonvulsants, antidepressants, surgery (if refractory)

________ Neuralgia;

-follows an outbreak of Herpes Zoster

-Intense burning pain, localized to affected nerve (same place as the zoster)


Postherpetic Neuralgia

Tx: antidepressants, anticonvulsants, opioids, & topical lidocaine patches

__________is a degenerative disorder of the cervical intervertebral discs

-osteophyte formation

-hypertrophy of adjacent facet joints & ligaments

-Sx: painful, stiff neck, shoulder pain, HA, paresthesias radiating down the arm, + Spurling maneuver


Cervical Spondylosis

Tx: NSAIDs, Cervical Immobilization, OMM, Muscle relaxers, Steroid injections, Surgery (if necessary)

_________a burning or aching pain of greater severity & duration (hyperpathia) than expected following trauma to an extremity

PE: muscle wasting, decreased ROM, cool & clammy extremity, temperature intolerance


Complex Regional Pain syndrome

(reflex sympathetic dystrophy (RSD))

Tx: Physical therapy (early stages), Gabapentin