Headaches Flashcards

Question

When to consider a preventive therapy for MA

Answer 1

1. Incidence of attacks ≥2-3 per month 2. Attacks are severe and impair normal activity 3. Patient is psychologically unable to cope with attacks 4. Optimal abortive therapies have failed or produced serious side effects Note: * some therapies (AMITRIPTYLINE) are indicated for depression BUT also tx MG * Valproic acid v. Topiramate v. PropranOLOL/MetoprOLOL; consider dosing other medical conditions, **SIDE EFFECTS**, and dosing regimen when selecting therapies * V-SE: weight gain, teratogenic, hair loss, liver and hematologic abnormalities * T-SE: lose weight, renal stones, angle closure glaucoma * OLOL: 2-for2

Answer 2

* Avoid triggers * Relaxation, biofeedback, acupuncture * Physical therapy * Dietary/vitamin supplementation (no scientific research): * Petadolex type of Butterbur * Vitamin B2, B6 * St.John’s Wort * Ginger * Gingko biloba * Fever few * Magnesium supplementation (+/-) * Coenzyme Q10 * \*\*Botulinum Toxin * Indicated only for **CHRONIC** MG HA * Usually approved only after a patient has *failed multiple medications* and *has multiple headache days per month* * Effective after 7-10 days up to 12 weeks

Answer 3

A 48 year old male presents for a **severe boring pain in the left eye**. What duration of symptoms is most consistent with cluster headaches...**\>30 minutes**

Answer 4

* **One of the most severe headaches** * More common in men (**4.5:1**) * Peak incidence **40-49y** * Often **heavy smokers & excessive alcohol use** * More common in the **spring & autumn** * Commonly occur at **night** * Symptoms usually “**side locked**” during cluster but **can switch sides** in subsequent attacks * Clusters last **6-12 weeks** * Typically occur every year or two * 85% episodic, 15% chronic/unremitting * ***1-4 attacks/day lasting 20m to 3hrs*** * ***Rapid onset over usually 15-30 minutes (not seconds)*** * ***Invariably unilateral*** * Alcohol nearly always triggers attacks * Can be associated with a **_partial Horner's & unilateral rhinorrhea_**

Answer 5

* Limited by headache duration 30- 90 minutes * *_Oral medications of little use_* * Effective medications * ***_Inhaled_* oxygen** 100% by rebreather at 10-15 L/min * ***_Injectable_* sumatriptan** * Nasal spray triptans * Intranasal lidocaine * Intranasal DHE * Prednisone (last choice) * 60-100 mg Qdaily for 5-7 days

Answer 6

* The most common form of HA (occurs in *35-75% of adults*) * Rarely severe & thus account for \<5% of visits * Clinical features * Bilateral pain lasting \>30 minutes, usually 4-6 hours * Band-like head pain with a “pressing” or “tightening” quality * Mild-to-moderate intensity * Not aggravated by routine activity * No N/V * Phonophobia & photophobia can occur but not both * Treatment is both pharmacologic & non-pharmacologic * Screen for *depression and sleep disorders* * May be responsive to *TCAs* (amitriptyline)-helps ppl fall asleep * Physiotherapy, biofeedback--adjust day-to-day activity

Answer 7

* Buzzwords: "SEVERE shooting/lightning pain radiating down the jaw" (vs. *cluster HA* usually *behind the EYE* and last MUCH longer) * Paroxysmal attacks of pain lasting from a fraction of a second to two minutes, affecting one or more divisions of the TN (trigeminal nerve) * worse with coughing, talking, chewing * Peak incidence **60-70**, CTN unusual before 40 * *MS is the most common assoced disease (idiopathic most common)* * Often end up at the dentist first for a root canal * Treatment: * **CARBAMAZEPINE effective for controlling pain (200-1200 mg/d)=first line therapy** * Oxcarbazepine is *probably* effective (600-1800 mg/d) * Baclofen & Lamotrigine are *possibly* effective

Answer 8

* most common in obese female pts on OCP with generalized HA * weight increasing intra-abdo pressure, decreases outflow, increases intracranial pressure--risk of BLINDNESS * Clinical Features: * ICP ≥250 mm H20 * No localizing features * No mass lesion or enhancement * Normal CSF content * No CVT (cerebral vein thrombosis) * *HA =presenting feature in ≥75%* * Tx: actezolamide, topiramate, surgical intervention

Answer 9

* Pulsating HA last from *5 min to 48 hours*, and occurring only **during or after physical activity** * Younger patients (**10-48 y/o**), usually **male** * Tx: * Beta-blockers * Indomethacin * Can treat for 3-6 months * {Jokl & Jokl (1968) * Described “effort migraines” during the Olympic Games * Athletes developed scotomas, retro-orbital pain, nausea, vomiting and prostration * Attributed to high altitude (7000 feet above sea level), heat, & humidity} * Note: Take NSAIDS before activity

Answer 10

1. Cluster 1. Location/Type: UNI-lateral/RETRO-orbital 2. Duration: 15/20 mins-to-3 hrs 3. Symptoms:excruciating peri-orbital pain with lacrimation 4. Tx:inhaled oxygen or injectable SUMATRIPTAN 2. Tension 1. Location/Type: BI-lateral 2. Duration: \>30 min (usually hours) 3. Symptoms: band-like pressure/pain 4. Tx: sleep, diet, exercise, simple analgesics 3. MG 1. Location/Type: UNI-lateral 2. Duration:4-72 hrs 3. Symptoms: PULSATING pain with photo/phonophobia 4. Tx: NSAIDS, Triptans

Headaches Flashcards

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