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Headaches
Primary vs Secondary
| Question | Answer |
|---|---|
| What is a primary headache? | It is not associated with other diseases, likely a complex interplay of genetic, developmental, and environmental risk factors. |
| Give three examples of primary headaches. | Migraine, cluster and tension. |
| What is a secondary headache? | It is associated with or caused by other conditions, generally will not resolve until the specific cause is diagnosed and addressed. |
| Tumors, intracranial bleeding, increased intracranial pressure, use of select medications such as nitrates, meningitis, accelerated hypertension, viremia, and giant cell arteritis are all examples of what classification of headache? | Secondary |
| What is the significance of the SNOOP mnemonic? | Consider a diagnosis other than primary headache if there is a positive "red flag" present in the SNOOP mnemonic. |
| What does the "S" stand for in the SNOOP mnemonic? | Presence of systemic symptoms (fever or weight loss) and secondary headache risk factors (HIV, malignancy, pregnancy, anticoagulation, hypertension, etc) |
| What does the "N" stand for in the SNOOP mnemonic? | Neurologic signs/symptoms (new neuro finding such as confusion, impaired alertness, nucal rigidity, hypertension, papilledema, cranial nerve dysfunction, abnormal motor function etc) |
| What does the first "O" stand for in the SNOOP mnemonic? | Onset (sudden, abrupt, "thunderclap") headache is suggestive of subarachnoid hemorrhage. If onset is with exercise, sexual activity, coughing and sneezing it is suggestive of increased intracranial pressure. |
| What does the second "O" stand for in the SNOOP mnemonic? | Onset (age at onset of headache) with older population identified as >50 yrs and younger <5yrs. Serious origin secondary headache are more likely to be found in individuals at either end of the lifespan. |
| What does the "P" stand for in the SNOOP mnemonic? | Previous headache history. (First headache in adult =>30yrs) primary headache pattern is usually established in youth-young adult years. New onset of different headache, change in attack frequency, severity or clinical features including progressive head |
| What type of headache presents with pressing, nonpulsatile mild to severe pain that is usually bilateral in location and has a duration of 30 minutes to 7 days? | Tension-type headache which is also limited to either nausea, or photophobia, or phonophobia. If there is more than one of these present then diagnosis of migraine should be considered. |
| What type of headache presents with a pulsating quality that is moderate to severe intensity causing avoidance of normal activities and may be either unilateral or bilateral in location? | Migraine without aura. Typically last 4-72 hours w/at least 2 of the following: nausea/vomiting, photophobia, phonophobia +fam hx (70-90%) and 3:1 females to males |
| What is the classic presentation for a migraine with aura? | Migraine-type headache occurs with or after aura. +fam hx 70-90% *focal dysfunction of cerebral cortex or brain stem causing >1 sx that develops over 4 mins or =>2 sx occuring in succession *sx can include feeling dread or anxiety, fatigue, nervousness |
| What type of headache occurs daily in groups or clusters over several weeks to months and then disappears for months to years? | Cluster headache. Occurs same time of day typically one hour into sleep and is more common in men than women. |
| A pressing, non-pulsatile pain is associated with what type of headache? | Tension. |
| What type of headache has a bilateral location? | Tension. (Occasionally migraine) |
| Which type of headache has a pulsating quality to the pain? | Migraine and occasionally cluster. |
| "Hot-poker" feeling in one eye is classic for which type of headache? | Cluster. |
| Nausea and photophobia are associated with what type of headache? | Migraine and sometimes cluster. |
| Unilateral location is common in which types of headaches? | Migraines and cluster. |
| Nasal stuffiness with conjunctival injection are ipsilateral autonomic signs associated with which headache? | Cluster. |
| Which headache has a severe crescendo pattern lasting 15 minutes to 3 hours located behind one eye awakening the person like an "alarm clock" and has earned the term "suicide headache"? | Cluster. |
| Which primary headache is the only one more common in men than women? | Cluster. |
| What lifestyle modifications can be utilized as treatment for primary headache? | Recognize and avoidance of known triggers, encourage regular exercise, proper posture, and use of tinted lens to minimize glare and bright lights. |
| What are common dietary triggers for migraines? | Sour cream, ripened cheeses, sausage, bologna, salami hot dogs, pizza,any pickled/fermented/marinated food, MSG, freshly baked yeast products, chocolate, nuts, onions, broad beans, figs/raisins/papayas/avocados, citrus foods, bananas, caffeine, alcohol an |
| What are potential lifestyle triggers for migraines? | Menses, ovulation, pregnancy, illness, intense or strenuous activity/exercise, altered sleep and eating patterns, bright or flickering lights, excessive or repetitive noises, odors, weather, high altitudes, medications, stress |
| What is the initial testing to support the presumptive diagnosis of giant cell arteritis? | Erythrocyte sedimentation rate. |
| Long-term, high dose systemic corticosteriod therapy is the recommended treatment for what type of secondary headache? | Giant cell arteritis. |
| In giant cell arteritis, what is a potential serious complication? | Blindness. |
| Which of the following represents the best choice of abortive migraine therapy for a 55 year old woman with angina pectoris? A. Verapamil B. Ergotamine C. Ibuprofen D. Almotriptan | Ibuprofen |
| A therapeutic option for prophylactic migraine treatment includes the use of: A. Propranolol B. Ergotamine C. Rizatriptan D. Clonidine | Propranolol |
| Which form of birth control is least desirable in a patient with a history of migraines? | Combined estrogen-progestin oral contraceptives. |
| A pt has a 10yr hx of migraines w/aura that occur 2-3X/mth that have a little response to the OTC medications with a normal neuro exam. She is questioning a need for testing to see what causes her headaches. What is your recommendation? | Keep a headache diary for the next month. |
| What is the best imaging modality if suspecting a tumor? | MRI |
| What is the best imaging modality to rule out hemorrhage? | Non-contrast CT |
| Which medications are migraine-specific? | Triptans (selective serotonin receptor agonists), select ergot derivatives |
Created by:
adunklow
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