Headaches 1-3 Flashcards Preview

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Flashcards in Headaches 1-3 Deck (105)
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1
Q

Primary headaches

A

migraine tension cluster

2
Q

secondary headaches

A

caused by underlying organic disease

3
Q

cervicogenic headaches

A

secondary although some classify as primary

4
Q

abnormal findings with headaches warrant what?

A

neuroimaging to rule out intracranial pathology

5
Q

what is the preferred method to rule out hemorrhage?

A

CT

6
Q

MRI is necessary for imaging what?

A

posterior fossa

7
Q

what are CSF analyses for?

A

hemorrhage infection tumor CSF disorders

8
Q

headache onset after 50 years is?

A

a red flag

9
Q

ddx for headaches beginning after 50 years

A

temporal arteritis mass lesion

10
Q

possible work ups for headaches beginning after 50

A

ESR/CRP, neural imaging

11
Q

ddx for sudden onset headache

A

subarachnoid hemorrhage mass lesion vascular malformation

12
Q

possible workup for sudden onset headache

A

neuroimaging lumbar puncture if neuroimaging is negative

13
Q

ddx for increased frequency and severity of headache

A

mass lesion subdural hematoma medication overuse

14
Q

possible workup for increasing frequency and severity of headache

A

neuroimaging drug screening

15
Q

red flags considering headaches

A

>50 years sudden onset increase in frequency and severity HIV/cancer systemic illness (fever, stiff neck, rash) focal neurological S&S papilledema subsequent to head trauma

16
Q

ddx for headache from HIV/cancer

A

meningitis abcess metastasis

17
Q

possible workup for headache from HIV/cancer?

A

neuroimaging lumbar puncture if neuroimaging is negative

18
Q

ddx for headaches from systemic illness

A

meningitis encephalitis lyme disease systemic infection collagen vascular disease

19
Q

possible workup for headaches from systemic illness

A

neuroimaging lumbar puncture serology

20
Q

ddx for focal neurological S&S

A

mass lesion vascular malformation stroke collagen vascular disease

21
Q

possible workup for headaches from focal neurological S&S

A

neuroimaging collagen vascular evaluation

22
Q

ddx for a headache with papilledema

A

mass lesion meningitis

23
Q

possible workup for headache with papilledema

A

neuroimaging lumbar puncture

24
Q

ddx for headache from subsequent trauma

A

intracranial hemorrhage subdural/epidural hematoma posttraumatic headache

25
Q

possible workups for headaches from subsequent trauma

A

neuroimaging of the brain, skull and possibly cervical spine

26
Q

migrain pain location

A

unilateral

27
Q

tension headache pain location

A

band like and bilateral

28
Q

cluster headache location

A

strictly unilateral

29
Q

temproal arteritis headache location

A

distribution of temporal artery

30
Q

trigeminal neuralgia pain location

A

distribution of trigeminal nerve

31
Q

acute glaucoma pain location

A

eye pain

32
Q

what is one of the most common cause of headaches?

A

whiplash

33
Q

4 primary headache patterns

A

migrain tension type cluster headache cervicogenic

34
Q

when must acute headache be evaluated?

A

if associated with neurologic S&S

35
Q

describe a migraine

A

associated with nausea, vomiting, or sleepliness and separated by pain free intervals

36
Q

what is a chronic progressive headache? What may be suspected?

A

severity and frequency increase over time structural disorder of CNS

37
Q

what is a chronic nonprogressive headache?

A

most typical type, usually related to stress

38
Q

most patients presenting to physician’s office for evaluation of headache have what?

A

either a tension headache or migraine

39
Q

S&S of a migraine

A

nausea photophobia phonophobia exacerbation by physical activity aura

40
Q

intracranial organic pathologies are from what?

A

infection intracranial mass lesion hemorrhage hypertensive parenchymal hemorrhage, subdural hematoma ischemic conditions traumatic brain injury

41
Q

other organic syndromes

A

cluster headache cranial bone pain scalp pain vascular involvement eye pain ear pain acute sinusitis dental pain facial nerve pain neck pain acute febrile illness metabolic disorders

42
Q

red flags for headaches

A

sudden, severe headache new headache, older patient headache due to head trauma associated residual neurologic S&S cognitive changes vomiting w/o nausea persistent or progressive headache nuchal rigidity with or without fever suspicion of drug or alcohol dependance headache associated w’ 15-mm Hg persistent/severe headache in child

43
Q

headaches associated with exertion may mean

A

underlying tumor or vascular weakness

44
Q

when do you do a CT/MRI for post traumatic headaches?

A

signs of neurological dysfunction and loss of consciousness

45
Q

most primary headaches occur when?

A

at an early age and are recurring

46
Q

when should a new headache be a concern?

A

if they are middle aged or older complaining of a new headache

47
Q

older patients with a temporal headache need to be considered to have..

A

temporal arteritis

48
Q

headaches that are constant and more severe without reprieve likely indicate

A

intracranial process and should necessitate a referral for evaluation

49
Q

how to manage a headache without red flags

A

modify patient behavior (sleep, diet, exercise) manage with CMT supplements or herbal alternates nonpharmacological treatments, if chiro is unsuccessful (acupuncture/biofeedback) refer for medical management if still unsuccessful

50
Q

migraines with aura tend to occur in who?

A

females

51
Q

how do migraines with aura usually present?

A

unilateral throbbing headaches that are preceeded by an aura

52
Q

the prodome of a migraine with auraconsists of what?

A

a progressively increasing scotoma (blind spot) surrounded by flashing lights lasting for about 30 minutes

53
Q

triggers for migraines with aura

A

sleeping or eating habits environmental pollutants certain medications food

54
Q

primary food triggers for migraines with aura

A

chocolate caffeine nitrates cheese nuts wine etc

55
Q

what neurological manifestations can be seen with migraines with aura?

A

aura olfactory paresthesias temporary weakness of facial muscles/limbs

56
Q

how long do migraines with aura last?

A

4-72 hours

57
Q

migraines without auras are usually..

A

female

58
Q

what do patients complain of with a migraine with aura?

A

unilateral, pulsatile headache that is recurrent, having begun as a young adult

59
Q

what neurological signs and symptoms are associated with migraines without aura?

A

there are none

60
Q

what is unique about migraines without aura?

A

the headache is severe, but they can still function

61
Q

what can relieve the migraine without aura?

A

vomiting (sometimes)

62
Q

are migraines more common with or without auras?

A

without

63
Q

what is the management for migraine without aura?

A

same as migraine with aura

64
Q

how will a patient describe a tension type headache?

A

frequent occurence that is often worse in the afternoon or early evening

65
Q

where is the pain for a tension headache?

A

bilateral in the suboccipital or supraorbital region

66
Q

are tension headaches due to muscle tension?

A

no, there is no higher incidence of muscle hypertonicity with tension headaches

67
Q

clinical features of tension headaches

A

bilateral headache mild to moderate intensity pressing or tightening quality (non-pulsating) non aggravated by routine physical activity absence of nausea and vomiting may have photophobia or phonophobia, but NOT BOTH

68
Q

pure cervicogenic headache without overlap can present as?

A

daily headaches with no associated neurological signs one sided reduced neck motion in the neck helps associated with neck pain

69
Q

cervicogenic headache is due to?

A

referral from soft tissues and articular structures in the neck

70
Q

cluster headaches occur in who mostly?

A

middle aged men

71
Q

what are the S&S of a cluster headache?

A

incredibly painful unilateral, orbital in location occur over days or weeks and then reappear again several weeks or months later history of smoking an possible alcohol use

72
Q

what is the average frequency of cluster headaches?

A

several times per day, often at night, lasting for one to several weeks

73
Q

what might the patient experience during a cluster headache?

A

lacrimation associated with a runny nose on the same side as the headache agitated and animated beat head against wall for relief they may attempt suicide

74
Q

does chiropractic help those with cluster headaches?

A

not clear

75
Q

what can be helpful in those with cluster headaches?

A

electrical stimulation of hypothalamus similar treatment to migraine with oxygen therapy

76
Q

who does temporal arteritis occur in?

A

patients older than 50

77
Q

what might the patient complain of with a tempral arteritis headache?

A

unilateral headache in temporal region tender nodule at the superficial temporal artery on side of forehead generalized aching and muscular tatigue int he upper trunk visual dysfunction or blindness of sudden onset

78
Q

what do you do with people with temporal arteritis?

A

immediate referral (because blindness can result)

79
Q

how is temporal arteritis treated?

A

corticosteroids

80
Q

what is elevated in temporal arteritis?

A

ESR and C reactive proteins

81
Q

what S&S would make you want to do advanced imaging on a headache patient

A

worsening with fever sudden onset w/ max intensity at 5 minutes new onset neurologic deficit or cognitive dysfunction change in personality impaired level of consciousness trauma within last 3 months headache from cough, valsalva or sneeze triggered by exercise orthostatic headache symptoms suggestive of giant cell arteritis, or acute glaucoma substantial change in characteristics of their headache

82
Q

what are the two types of stroke?

A

ischemic* hemorrhagic

83
Q

what do you do with someone who you suspect is having a stroke?

A

FAST face drooping arm weakness slurred speech time counts (911)

84
Q

S&S of a hemorrhagic stroke

A

worst headache of my life extremely sudden onset if the doc can’t distinguish between migraine or tension type preceeded by sentinel*** headache in a lot of patients

85
Q

sentinel headache

A

sudden, intense and persistene, preceeding spontaneous subarachnoid hemorrhage by days or weeks

86
Q

warning signs of a potential dissection

A

sudden onset of headache, neck pain, face pain pain that is different than patient has experienced before 5Ds And 3Ns Dizziness Drop attacks Diplopia Dysarthria Dysphagia Ataxia Nausea Numbness Nystagmus

87
Q

papilledema

A

optic swelling that is secondayry to elevated intracranial pressure

88
Q

what happens to vision with papilledema?

A

nothing, usually well preserved acutely

89
Q

what will you see in someone’s eye if they have papilledema

A

obliteration of physiologic cup tortuous vessels

90
Q

what are the intracranial structures that are pain sensitive?

A

meningeal arteries proximal protions of cerebral arteries dura at the base of the brain venous sinuses CN 1, 2, 3, 5, 7, 9

91
Q

brain tumor symptoms

A

headaches seizures sensory and motor loss hearing loss vision loss fatigue depression behavioral and cognitive changes endocrine dysfunction

92
Q

describe the headaches of people who have brain tumors

A

steady pain, worse upon waking, better in a few hours persistent, progressive, non migraine aggravated by valsalva maybe vomiting maybe throbbing maybe worse with coughing, exercise or change in body position doesn’t respond to regular headache remedies maybe associated with new neurologic findings

93
Q

symptoms specific to the location of the tumor

A

pressure or headache near the tumor

94
Q

symptoms specific to a tumor of a cerebellum

A

loss of balance and difficulty with fine motor skills

95
Q

symptoms specific to a tumor of the cerebrum

A

changes in judgement loss of initiative, sluggishness, muscle weakness, paralysis (frontal lobe) partial or complete loss of vision (occipital or temporal lobe of cerebrum) changes in speech, hearing, memory, or emotional state (aggressiveness)(frontal and temporal lobe of cerebrum) altered perception of touch or pressure, arm or leg weakness on one side of the body or confusion with left and right sides(frontal or parietal lobe)

96
Q

pineal gland tumr

A

inability ot look upward

97
Q

pituitary tumor

A

lactation and altered menstrual periods in women growth in hands and feet in adults

98
Q

brain stem tumor

A

difficulty swallowing, facial weakness or numbness, double vision vision changes (temproal, occipital lobe, brain stem)

99
Q

most prevalent brain tumor types

A

gliomas (glioblastoma multiforme, ependymomas, astrocytomas, oligodendrogliomas) meningiomas

100
Q

most prevalent tbrain tumor types on children

A

astrocytoma medulloblastoma ependymoma

101
Q

normal measurement for sella turcica

A

16 across x 12 depth on a 40” film

102
Q

if the sella turcica is large, it could be?

A

empty sella tumor normal aneurysm

103
Q

most common symptom of chiari malformation

A

headache that begins at the back of the head and radiates upward made worse by coughing, sneezing or straining

104
Q

other common symptoms of chiari malformation

A

dizziness vertigo disequilibrium visual disturbances ringing in ears difficulty swallowing palpitations sleep apnea muscle weakness impaired fine motor skils chronic fatigue painful tingling of hands and feet

105
Q

chiari measurement

A

vertical distance from tip of cerebellar tonsils to a line drawn betwen and anterior and posterior margins of the foramen magnum normal less than 3mm