Course 6207 > Headache > Flashcards

Headache Flashcards

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1
Q

What is indicated for abrupt-onset ‘thunderclap headache’, head injury, or headache with associated neurologic abnormalities?

A

Immediate emergency department referral

This includes cases with change in mental status.

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2
Q

What percentage of the population experiences headache?

A

90% to 95%

Headache is the third most common complaint and cause of disability in the world.

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3
Q

True or false: Many people with headache are diagnosed by a physician.

A

FALSE

Research indicates that many patients with headaches are never diagnosed.

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4
Q

What do many patients with headaches use instead of prescribed medications?

A
  • OTC medications
  • Home remedies

This occurs even with the development of newer medications.

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5
Q

What is the difference between primary and secondary headaches?

A
  • Primary headaches are not symptomatic of another medical condition
  • Secondary headaches can indicate a more serious medical problem

Secondary headaches may result from conditions such as aneurysm, tumor, hemorrhage, temporal arteritis, or meningitis.

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6
Q

Name the types of primary headaches.

A
  • Migraine with aura
  • Migraine without aura
  • Chronic tension-type headaches
  • Episodic tension-type headaches
  • Trigeminal autonomic cephalalgias (TAC)
  • Medication overuse or rebound headache

Primary headaches affect people of all ages and have a significant lifetime prevalence.

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7
Q

What is the estimated lifetime prevalence of primary headache disorders in adults worldwide?

A

47%

Headaches account for up to 4% of all emergency department visits.

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8
Q

True or false: Tension-type headaches have a lifetime prevalence of up to 78% in the general population.

A

TRUE

Tension-type headaches are one of the most common reasons to consult a health care provider.

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9
Q

What are some diseases that have a relationship with migraine?

A
  • Epilepsy
  • Major depression
  • Panic disorder
  • Celiac disease
  • Raynaud syndrome
  • Cardiac shunting

The neurotransmitter serotonin has been suggested as a basis for both migraine and major depression.

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10
Q

What was the vascular theory regarding headaches?

A

Headaches were thought to be caused by increased blood flow to the head, resulting in distended vessels and pressure on nerve fibers

This theory was popular until the 1930s when it was determined that migraine involves both vascular and chemical changes.

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11
Q

Which neurochemical is a powerful vasoconstrictor involved in migraine development?

A

Serotonin (5-hydroxytryptamine [5-HT])

Serotonin sensitizes blood vessel walls to painful dilation.

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12
Q

What role do neurogenic inflammation and neurochemicals play in headaches?

A

They are responsible for the pain of migraine

Changes in vasculature and neurochemicals occur in response to a headache trigger.

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13
Q

Fill in the blank: The exact mechanism of a headache is still ______.

A

debated

There is a genetic component and often a family history of migraine.

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14
Q

What are the two major types of migraine?

A
  • Migraine with aura
  • Migraine without aura

Migraine without aura is the more common of the two types.

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15
Q

Describe the pain associated with migraine without aura.

A
  • Ipsilateral headache
  • Pounding or throbbing
  • Moderate to severe intensity
  • Aggravated by physical activity
  • Lasts 4 to 72 hours

Associated symptoms may include nausea, vomiting, photophobia, and phonophobia.

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16
Q

What are common triggers for migraines?

A
  • Medication overuse
  • Obesity
  • Depression
  • Stressful life events
  • Sleep problems
  • Weather changes
  • Foods (cheese, chocolate)
  • Alcohol
  • Change in altitude
  • Delay or skipping of a meal
  • Hormonal changes

Triggers are individual characteristics and may not always stimulate a headache.

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17
Q

What is the classic aura in migraine with aura?

A
  • Jagged lines (fortification spectrum)
  • Spots
  • Shimmering bright lights
  • Areas of visual loss (scotomas)

The aura usually occurs before the onset of head pain.

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18
Q

What is a prodrome in the context of migraines?

A
  • Feelings of doom
  • Fatigue
  • Increased irritability
  • Decreased energy
  • Food cravings

This can signal an impending severe headache.

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19
Q

How are acute tension-type headaches characterized?

A
  • Tight band-like sensation around the head
  • Mild pain
  • Not exacerbated by activity
  • Lasts minutes to hours

Criteria allow for photo or phonophobia but not nausea or vomiting.

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20
Q

What differentiates chronic tension-type headache from acute?

A

Occurs more than 15 days per month

Similar in presentation to acute tension-type headache.

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21
Q

What are Trigeminal Autonomic Cephalalgias (TAC)?

A
  • Group of headache syndromes
  • Differentiated by duration and frequency
  • Unilateral autonomic symptoms

Cluster headaches are the most well-known type.

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22
Q

Describe the pain associated with cluster headaches.

A
  • Severe unilateral, retro-orbital pain
  • Reaches maximum intensity in about 15 minutes
  • Lasts about 90 minutes
  • Can occur several times per day

Patients often cannot sit still and may exhibit restlessness.

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23
Q

What are some features of cluster headaches?

A
  • Ipsilateral conjunctival injection
  • Lacrimation
  • Rhinorrhea
  • Partial Horner sign

Attacks can occur in groups lasting days to weeks.

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24
Q

True or false: The history is the most important part of the evaluation for primary headache disorders.

A

TRUE

Diagnosis can often be made based on the history alone.

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25
What should be included in a **medication profile** for headache evaluation?
* Medications tried in the past * OTC medications used per month ## Footnote Patients may not view OTC drugs as medications.
26
What key aspects should be focused on during a **physical examination** for headaches?
* Fundoscopic and pupillary assessment * Auscultation of the carotid and vertebral arteries ## Footnote Examination findings in primary headache disorders are usually within normal limits.
27
What is included in a **mental status examination** for headache evaluation?
* Palpation of the head, neck, and temporal arteries * Evaluation for neck stiffness, focal weakness, sensory loss, and gait * Vital signs ## Footnote These components help assess the patient's neurological status and identify potential underlying issues.
28
Many patients with **tension-type headaches** or **migraines** have tight _______.
cervical musculature ## Footnote This tightness can lead to general aches and pains similar to fibromyalgia.
29
What symptoms may indicate **sinusitis**?
* Pain and pressure on palpation of the sinuses * Puru-lent nasal discharge ## Footnote These symptoms suggest inflammation or infection of the sinuses.
30
True or false: Clicking and popping of the **temporomandibular joints** is often the cause of a headache.
FALSE ## Footnote While tension in the musculature surrounding the joint can contribute to headache pain, it is rarely the primary cause.
31
What are serious symptoms that may accompany a headache indicating a need for further evaluation?
* Stiff neck * Fever * Malaise * Nausea or vomiting * Presence of aphasia, weakness, or poor coordination ## Footnote These symptoms may suggest a more serious underlying condition.
32
What does the mnemonic **SNOOP** help identify?
Dangerous underlying conditions ## Footnote It stands for Systemic symptoms, Neurological signs, Onset, Older patient, and Previous headache history.
33
List some **danger signs** that warrant further investigation in headache patients.
* Asymmetry of pupillary responses * Decreased deep tendon reflexes * Headache described as 'the worst ever experienced' * Personality change * Onset of a headache that progressively worsens * Papilledema * Painful temporal arteries ## Footnote These signs may indicate serious neurological issues.
34
What are the **three principles** for diagnostic testing according to the US Headache Consortium?
* Testing should be avoided if it will not change management * Testing is not indicated if the patient is not significantly more likely to have an abnormality * Testing may be appropriate for patients excessively concerned about serious problems ## Footnote These principles guide clinicians in making appropriate diagnostic decisions.
35
What are the **essential laboratory tests** for headache diagnostics?
* None ## Footnote Most primary headache cases do not require laboratory testing unless specific concerns arise.
36
What are some **additional laboratory tests** that may be indicated?
* Complete blood count (CBC) * Erythrocyte sedimentation rate (ESR) * C-reactive protein (CRP) * Thyroid function tests ## Footnote These tests help exclude conditions like anemia, temporal arteritis, and thyroid dysfunction.
37
What are the **priority differential diagnoses** for headache with neurological signs?
* Brain hemorrhage * Meningitis * Pseudotumor cerebri * Temporal arteritis * Rheumatologic disorders (e.g., lupus, rheumatoid arthritis) ## Footnote These conditions require urgent evaluation in patients presenting with concerning symptoms.
38
What are the **primary headaches** mentioned?
* Migraines * Tension-type headaches * TAC (e.g., cluster headache) * Medication overuse headaches * Caffeine withdrawal headaches ## Footnote These are classified as primary headaches, distinct from secondary headaches caused by other conditions.
39
What are some **infectious or inflammatory causes** of headache?
* Fever * Meningitis * Temporal arteritis * Lyme disease * Trigeminal neuralgia * Rheumatoid arthritis * Systemic lupus erythematosus * Sinusitis ## Footnote These conditions can present with headache as a symptom.
40
What are some **structural causes** of headache?
* Tumor * Hemorrhage * Aneurysm * Subdural hematoma ## Footnote These structural issues can lead to significant headache symptoms.
41
What are some **metabolic causes** of headache?
* Thyroid dysfunction * Pheochromocytoma * Sleep apnea ## Footnote These metabolic disorders can manifest as headache symptoms.
42
What does **non-pharmacologic management** of headaches include?
* Behavior modification * Biofeedback * Acupressure * Management of headache triggers * Wellness program ## Footnote These methods aim to control headaches without medication.
43
What is **biofeedback** in the context of migraine management?
Use of instrumentation to bring under voluntary control physiologic processes ## Footnote Example: Teaching migraineurs to raise hand temperature to prevent an attack.
44
What can be depressed during a headache to offer relief?
Area between the thumb and the first finger ## Footnote This pressure may release endogenous endorphins and adrenocorticotropic hormones.
45
What are the components of a **wellness program** that can help with headaches?
* Balanced meals * Regular exercise * Adequate sleep ## Footnote Helps avoid triggers that might initiate headaches.
46
Why is it important for a patient to keep a **headache diary**?
Documents number of headaches, triggers, and treatment successes and failures ## Footnote Should be kept daily for accuracy and brought to office visits.
47
What are the two areas of **pharmacologic treatment** for headaches?
* Abortive therapy * Preventive therapy ## Footnote Management should match the level of therapy to the intensity of the headache.
48
When is **preventive therapy** appropriate for headache patients?
* Unable to deal with attacks * More than four headaches a month * Attacks are prolonged and refractory to medicine ## Footnote Given daily to decrease headache intensity and frequency.
49
Name some **anticonvulsants** used to control migraines.
* Divalproex sodium (Depakote) * Gabapentin (Neurontin) * Topiramate (Topamax) ## Footnote Connection shown between epilepsy and migraine.
50
What type of medication may benefit patients with **Raynaud phenomenon** or hypertension?
Calcium channel blockers ## Footnote Examples: Diltiazem (Cardizem), Amlodipine (Norvasc).
51
What is the role of **B blockers** in headache management?
May be chosen for patients with palpitations caused by mitral valve prolapse or panic disorders ## Footnote Should be avoided in those with asthma.
52
What is the mechanism of action for **calcium channel blockers**?
Prevent calcium from entering cells, decreasing excitability ## Footnote May prevent vascular spasm and headache.
53
What do **tricyclic antidepressants** and **SSRIs** do in headache management?
Modulate levels of serotonin in the brain ## Footnote Both have extensive side effect profiles.
54
What is **OnabotulinumtoxinA** used for?
Prevention of chronic migraine ## Footnote FDA approved for patients with ≥15 days per month of headache.
55
What is the purpose of **abortive therapy**?
Treat intensity and duration of pain during an attack ## Footnote Also manages associated symptoms like nausea and vomiting.
56
What should patients be instructed regarding **abortive medication**?
Take an appropriate amount initially to abort the headache ## Footnote Depends on prior response to treatment and presence of nausea.
57
What condition can develop from frequent use of **analgesics**?
Analgesic rebound ## Footnote Conventional thinking suggests it may potentiate headaches.
58
What are first-line treatments for mild to moderate headaches?
* Acetaminophen * Aspirin ## Footnote Caffeine combinations can potentiate their absorption and analgesia.
59
What is the safety profile of **Naproxen sodium** compared to other NSAIDs?
Has a longer half-life and better safety profile ## Footnote Example: Anaprox DS, Aleve.
60
What is the role of **metoclopramide** when added to NSAIDs?
Facilitates absorption and potentiates effect ## Footnote It is particularly useful when nausea is present.
61
Name the two forms of **ergot derivatives** currently in use.
* Ergotamine tartrate * Dihydroergotamine ## Footnote Ergotamine tartrate is available in rectal and oral forms, with the rectal dose being more potent.
62
What is the **route of administration** for dihydroergotamine?
* Injectable * Nasal spray ## Footnote The injectable form can be given parenterally, subcutaneously, or intramuscularly.
63
True or false: **Ergot derivatives** are considered first-line therapy for migraines.
FALSE ## Footnote With the development of triptans, ergot derivatives are no longer considered first-line therapy.
64
What do **triptans** target in the brain?
Specific receptors (5-HT) ## Footnote They are effective for migraine and cluster headache relief.
65
List the **forms** in which triptans are available.
* Oral * Quick melt * Transnasal * Injectable * Transdermal ## Footnote Different brands may have slight differences in effectiveness.
66
What is the **first-line preventive therapy** for cluster headaches?
* Verapamil * Lithium ## Footnote Verapamil is well tolerated, while lithium requires monitoring for toxicity.
67
What is the recommended **oxygen delivery rate** for cluster headache treatment?
10 to 15 L/min ## Footnote Oxygen should be inhaled at the start of an attack and can be effective in 75% of patients.
68
For **tension-type headaches**, what medications may be helpful for mild attacks?
* NSAIDs * Muscle relaxants (e.g., metaxalone, carisoprodol) ## Footnote Anti-emetics are usually not necessary due to the absence of nausea.
69
Indications for referral to a specialist include headaches that are __________.
Not easily controlled by routine headache medicines ## Footnote Other indications include new and progressively worsening headaches or those affecting quality of life.
70
What is the goal of the **US1 Headache Consortium's** guidelines for migraine?
* Reducing frequency of attacks * Improving response to therapy * Restoring normal functioning ## Footnote These guidelines cover both non-pharmacologic and pharmacologic modalities.
71
As patients age, headaches often __________.
Decrease ## Footnote It is uncommon for headaches to appear after the age of 50 years.
72
What should be used more conservatively in elderly patients with headaches?
* Divalproex sodium * Metoclopramide * Intravenous magnesium * Naproxen * Hydroxyzine ## Footnote Triptans and DHE pose risks due to their vasoconstrictive properties.
73
What is the **most serious complication** of headache misdiagnosis?
Delay in diagnosis and treatment ## Footnote This can lead to poor outcomes, with an average delay of 10 years for TAC diagnosis and years of inappropriate treatment.
74
What medication can be safely used during **pregnancy** for headache control?
Acetaminophen ## Footnote It should be used at doses within normal parameters.
75
List some **complications** associated with headaches.
* Status migrainosus * Dependency on narcotics, barbiturates, tranquilizers * Side effects of medication * Inadequate treatment * Interruption of daily activities ## Footnote These complications can significantly affect a patient's quality of life.
76
What neurotransmitter is released during acute **migraine** and cluster headache attacks?
Calcitonin gene-related peptides (CGRP) ## Footnote This release occurs into the cranial venous outflow.
77
What are **gepants** and their role in headache management?
CGRP receptor antagonists ## Footnote They are showing positive relief of acute and chronic migraine and cluster headache with few side effects.
78
What was the first CGRP antagonist approved by the **FDA** in 2018?
Erenumab (Aimovig) ## Footnote Galcanezumab (Emgality) was also approved around the same time.
79
What is the purpose of **patient and family education** in headache management?
To enable choices and regain control ## Footnote Open communication and reassurance are necessary as many patients fear they have a life-threatening condition.
80
True or false: Educational materials on headaches are available to the public for free.
TRUE ## Footnote Pharmaceutical companies and organizations like the American Headache Society provide written information about headaches.
81
What is the recommended approach for **preventive therapy** in pregnant women experiencing headaches?
Taper immediately ## Footnote Headache control during pregnancy is usually limited to abortive medications.
82
What is a common misconception among patients regarding their **headache** condition?
They believe they have a life-threatening condition ## Footnote It is important to reassure them that their physical examination findings are normal.
83
What is the purpose of **national groups** for headache patients and their families?
To provide support and information ## Footnote These groups encourage patients and families to join for additional resources.
84
Name one website that provides information and support for headache patients.
* International Headache Society (www.ihs-headache.org) ## Footnote This is one of several organizations dedicated to headache research and support.
85
List two organizations that support headache patients.
* American Migraine Foundation (americanmigrainefoundation.org) * European Headache Federation (www.ehf-org.org) ## Footnote These organizations offer resources and support for individuals dealing with headaches.
86
True or false: The **Cluster Busters** organization focuses on cluster headaches.
TRUE ## Footnote Cluster Busters is dedicated to providing support and information specifically for cluster headache sufferers.
87
Fill in the blank: The **International Association for the Study of Pain** can be found at _______.
www.iasp-pain.org ## Footnote This organization focuses on pain research and education.
88
What is the website for the **British Association for the Study of Headache**?
www.bash.org.uk ## Footnote This organization provides resources and support for headache research in the UK.
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