Most common type of HA:
Tension (W > M)
SNOOP 4 flags for headache:
Systemic disease Neurologic signs Onset that is sudden Onset that is over 40 Previous HA with new features Progressive Postural Precipitation by valsalva/exertion
Migraines will hit their max pain usually in:
1-2 hours
What is a defining feature of migraines vs. SAH:
Transient with ipsilateral tearing and rhinorrhea
Imaging needed for HA:
MRI without contrast
Frequencies of HA:
Infrequent: <1 d/month
Frequent: 1-14
Chronic: >15/month
Tension headache does NOT
Throb - it is a headband of pressure
TTH has at least two of the following (4):
- Bilateral head or neck pain
- steady pressing or tightening and non-throbbing pain
- Mild to moderate pain
- not aggravated by normal physical activity
Best treatment for tension
Rest
Do not want to treat a HA for more than how many days a month (risk of developing MOH)?
More than 9
Treatment for Tension headaches (4):
- Ibuprofen (600 I; 800 I)
- APAP 1000 x1
- Ketorolac injection IM
- Excedrin with caffeine (APAP)
Cannot use what in pregnancy?
NSAIDS
A menstrual migraine (starting 2-3 days) from too low estrogen does not have:
An aura
Cluster headaches are more common:
In men and at night
Cluster headaches have:
Throbbing
Two most common types of aura:
- visual
2. Sensory
What is cutaneous allodynia?
Perception of pain produced by the innocuous stimulation of normal skin
What type of headache affects young women and children?
Basilar - Vertigo + dysarthria
Retinal ocular migrants result in:
Monoocular stomata that lasts an hour that is followed by a HA
If you have someone with migrainous vertigo make sure they do not have:
Meniere’s
Migraine without aura (more common) has more than two of the following 4:
- Unilateral location
- Pulsating quality
- Moderate-serve intensity
- aggravation by routing physical activity
Food triggers are more likely to tip off a:
Migraine
Why do oral agents not work as well when someone has a migraine?
Because there is secondary gastric stasis
Options for acute treatment of a migraine:
- NSAID +/- APAP
- Triptan (inhaled)
- Ergots
