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Headaches

Primary vs Secondary

QuestionAnswer
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