p.7
Pathophysiology of Headaches
What is the role of primary nociceptors in pain perception?
They are stimulated to initiate the pain response.
p.15
Migraine Characteristics and Epidemiology
How was the term 'hemikrania' transformed in Latin?
It was corrupted into low Latin as 'hemigranea'.
p.30
Tension-Type Headaches
What type of pain is associated with tension-type headaches?
Mild to moderate pressure and tightness.
What are some other common triggers for migraines?
Trauma, exertion, stress/anxiety, and schedule changes.
p.48
Diagnosis of Headaches
What should be recorded regarding the frequency of pain in a headache diary?
The frequency of headache occurrences.
What characterizes the frequency of cluster headache attacks?
Attacks are clustered in time, with more than 5 attacks.
p.48
Diagnosis of Headaches
What aspects of pain quality should be noted in a headache diary?
The quality of pain experienced.
What type of pain is associated with cluster headaches?
Severe unilateral, orbital, supraorbital, and/or temporal pain.
p.48
Diagnosis of Headaches
What duration information is important to track in a headache diary?
The duration of each headache episode.
Which nerve is affected in trigeminal neuralgia?
The trigeminal nerve (cranial nerve V).
p.25
Treatment Options for Headaches
What are neuroleptics and antiemetics used for in headache treatment?
They are used to manage symptoms associated with headaches.
What are episodic syndromes that may be linked to migraines?
Episodic syndromes that may be associated with migraine.
Is there a gender predisposition for trigeminal neuralgia?
Yes, there is a female preponderance.
p.48
Diagnosis of Headaches
What triggers should be documented in a headache diary?
Hormonal, environmental, food, and drug triggers.
What does the term 'tic douloureux' refer to?
The obvious movement or tic produced by the pain.
p.12
Overview of Headaches
What factors are important in determining headache characteristics?
Frequency, location and radiation, quality, alleviating and exacerbating factors, and associated symptoms.
p.37
Treatment Options for Headaches
What is abortive treatment for headaches?
Treatment aimed at relieving symptoms during an attack, such as oxygen, triptans, ergot alkaloids, and anesthetics.
p.26
Treatment Options for Headaches
What is the purpose of prophylaxis in headache management?
To prevent the occurrence of headaches.
p.45
Secondary Headaches and Red Flags
What role do the cervical spine and ligaments play in secondary headaches?
They are part of the extra-cranial pain-sensitive structures.
How often do cluster headaches occur?
They occur in cyclical patterns or clusters, often lasting weeks to months.
How often do cluster headaches occur?
They occur every year or season.
p.46
Secondary Headaches and Red Flags
What is a secondary headache?
A headache attributed to another condition, such as trauma or injury to the head and/or neck.
p.22
Secondary Headaches and Red Flags
What is HSV encephalitis?
A viral infection of the brain caused by the herpes simplex virus.
p.47
Secondary Headaches and Red Flags
What changes in mental status are red flags for headaches?
Change in level of consciousness, personality, or lethargy.
What physical symptom often accompanies the pain in trigeminal neuralgia?
A brief facial spasm or tic.
p.27
Tension-Type Headaches
How long can tension headaches last?
They can last from 30 minutes to several days.
p.47
Secondary Headaches and Red Flags
What is a specific tenderness that can be a red flag for headaches?
Temporal artery tenderness.
p.43
Diagnosis of Headaches
What is the duration of pain in paroxysmal attacks according to the diagnostic criteria?
From a fraction of a second to 2 minutes.
p.3
Diagnosis of Headaches
What is important to know regarding 'dangerous' headaches?
How to 'rule out' other conditions.
p.31
Treatment Options for Headaches
What is important to recognize in the treatment of headaches?
Comorbid illnesses such as migraine, anxiety, and depression.
p.16
Migraine Characteristics and Epidemiology
In the Global Burden of Disease Survey 2010, where was migraine ranked in terms of prevalence?
Third most prevalent disorder.
p.10
Overview of Headaches
What causes secondary headaches?
Caused by exogenous disorders.
p.16
Migraine Characteristics and Epidemiology
What was the ranking of migraine as a specific cause of disability worldwide in 2010?
Seventh-highest specific cause of disability.
What type of headache disorder is cluster headache classified as?
Neurovascular primary headache disorder.
What are cluster headaches?
Severe headaches that occur in cyclical patterns or clusters.
p.22
Secondary Headaches and Red Flags
What are dissection syndromes?
Conditions caused by a tear in the artery wall, often leading to headaches.
p.46
Secondary Headaches and Red Flags
What causes a secondary headache related to non-vascular intracranial disorders?
Conditions affecting the brain that are not related to blood vessels.
How many episodes can occur in a day for cluster headaches?
Several episodes per day.
p.47
Secondary Headaches and Red Flags
What indicates systemic signs or symptoms as red flags for headaches?
Presence of systemic signs or symptoms.
p.7
Pathophysiology of Headaches
What happens to pain-producing pathways in the PNS and CNS during pathophysiology?
Lesions occur in these pathways.
p.12
Overview of Headaches
What are constitutional symptoms in relation to headaches?
Symptoms that may accompany headaches, indicating a systemic issue.
p.12
Overview of Headaches
What past medical history factors are relevant to headaches?
Hypertension (HTN), diabetes mellitus (DM), hyperlipidemia, and smoking.
What actions related to personal care can trigger pain?
Touching, shaving, brushing teeth, blowing the nose.
What are the three main types of primary headaches?
Migraine, Tension Headache, and Cluster Headache.
p.14
Migraine Characteristics and Epidemiology
What characterizes a migraine?
Severe, often unilateral headache accompanied by nausea, vomiting, and sensitivity to light and sound.
p.45
Secondary Headaches and Red Flags
Which structures in the head are sensitive to pain and can contribute to secondary headaches?
Both extra-cranial and intracranial structures.
What is the typical distribution of pain in trigeminal neuralgia?
Unilateral pain following the sensory distribution of trigeminal nerve V.
p.8
Pathophysiology of Headaches
What factors related to muscles can contribute to headaches?
Spasm, inflammation, and trauma to cranial and cervical muscles.
p.26
Treatment Options for Headaches
Name two medications that are 5-HT2 antagonists used for headache prophylaxis.
Cyproheptadine and Methysergide.
p.48
Diagnosis of Headaches
What types of accompanying symptoms should be recorded in a headache diary?
Neurologic symptoms (e.g., visual disturbance) and autonomic symptoms (e.g., nausea).
p.16
Migraine Characteristics and Epidemiology
What characterizes the episodes of migraines?
Attended by pain-free interludes and provoked by stereotyped stimuli.
p.13
Diagnosis of Headaches
What does meningismus indicate?
Possible irritation of the meninges, often associated with meningitis.
What triggers cluster headaches?
Triggers can include alcohol, smoking, and changes in sleep patterns.
What is a headache?
A symptom of pain anywhere in the region of the head or neck.
p.30
Tension-Type Headaches
Where is the pain located in tension-type headaches?
Both sides of the head and neck.
What is a primary headache?
A headache not caused by another medical condition.
What is trigeminal neuralgia?
A chronic pain condition affecting the trigeminal nerve, causing severe facial pain.
p.8
Pathophysiology of Headaches
What type of irritation can contribute to headaches?
Meningeal irritation due to underlying inflammation.
p.13
Diagnosis of Headaches
What does fundoscopy examine?
The interior surface of the eye, including the retina.
p.44
Treatment Options for Headaches
What is an example of a percutaneous procedure for headache treatment?
Percutaneous retrogasserian glycerol rhizotomy.
p.28
Pathophysiology of Headaches
What is believed to be the more likely cause of tension-type headaches?
Abnormal neuronal sensitivity and pain facilitation.
p.44
Treatment Options for Headaches
What type of surgery can be performed for headache treatment?
Microvascular decompression.
p.28
Pathophysiology of Headaches
Is abnormal muscle contraction considered the main cause of tension-type headaches?
No, it is not believed to be the main cause.
What are some treatment options for trigeminal neuralgia?
Medications, nerve blocks, and surgical options.
p.23
Diagnosis of Headaches
What should be excluded to differentiate migraine from other headaches?
Structural, metabolic, and other causes that can mimic or coexist with migraine.
p.24
Treatment Options for Headaches
What are some elements of a healthy lifestyle action plan?
Proper nutrition, regular physical activity, adequate sleep, and stress reduction strategies.
p.21
Migraine Characteristics and Epidemiology
What is a migrainous aura?
A neurological phenomenon that occurs before or during a migraine attack, often involving visual disturbances.
What hormonal changes can trigger migraines?
Menstruation, menopause, and pregnancy.
p.30
Tension-Type Headaches
What symptoms are absent in tension-type headaches?
No light or sound sensitivity, no aura.
p.25
Treatment Options for Headaches
What type of medications are used for acute attacks of headaches?
Nonspecific medications like Aspirin, NSAIDs, combination analgesics, opioids, neuroleptics/antiemetics, and corticosteroids.
p.44
Treatment Options for Headaches
Which medications are considered second-line therapies?
Lamotrigine and baclofen.
p.25
Treatment Options for Headaches
What are examples of specific medications for acute headache attacks?
Ergotamine/DHE and Triptans.
What is the typical duration of a cluster headache attack?
Typically lasts from 15 minutes to 3 hours.
What are some symptoms that may accompany cluster headache attacks?
Ipsilateral conjunctival injection, lacrimation, nasal congestion, rhinorrhea, eyelid edema, facial sweating, flushing, fullness in the ear, miosis, and/or ptosis.
Who is most commonly affected by trigeminal neuralgia?
It is more common in women and individuals over the age of 50.
p.47
Secondary Headaches and Red Flags
What associated symptoms are considered red flags for headaches?
Focal neurologic findings.
p.25
Treatment Options for Headaches
What role do corticosteroids play in headache treatment?
They are used for acute attacks.
What are some examples of other primary headache disorders?
Hemicrania continua and primary stabbing headache.
What triggers cluster headaches?
Triggers can include alcohol, smoking, and changes in sleep patterns.
What dietary factors can trigger migraines?
Hunger, alcohol, additives, and caffeine withdrawal.
What environmental factors can trigger migraines?
Visual stimuli, odors, and changes in barometric pressure.
p.8
Pathophysiology of Headaches
What can cause traction or displacement in headache mechanisms?
Large intracranial veins or their envelope.
p.13
Diagnosis of Headaches
What is the purpose of measuring blood pressure during a physical examination?
To assess cardiovascular health and detect hypertension.
What type of pain syndrome is trigeminal neuralgia?
A distinctive facial pain syndrome that may become recurrent and chronic.
p.8
Pathophysiology of Headaches
What can lead to compression or inflammation in headache mechanisms?
Cranial or spinal nerves.
p.13
Diagnosis of Headaches
What is auscultation for bruits used to detect?
Abnormal blood flow or turbulence in blood vessels.
p.13
Diagnosis of Headaches
What is the significance of temporal artery inspection and palpation?
To check for inflammation or abnormalities in the temporal artery.
p.26
Treatment Options for Headaches
What is another class of medication used for headache prophylaxis besides beta-blockers?
Calcium channel blockers.
p.33
Migraine Characteristics and Epidemiology
Is there a gender difference in the occurrence of cluster headaches?
Yes, more common in males than females (M>F).
What is a common treatment for cluster headaches?
Oxygen therapy and medications like triptans.
p.18
Pathophysiology of Headaches
What system is activated that stimulates pain in headaches?
The trigeminovascular system.
p.43
Diagnosis of Headaches
Which nerve divisions are affected by the pain in trigeminal neuralgia?
One or more divisions of the trigeminal nerve.
p.8
Pathophysiology of Headaches
What causes distension, traction, or dilatation of arteries in headache mechanisms?
Intracranial or extra cranial arteries.
p.16
Migraine Characteristics and Epidemiology
What is a migraine?
A benign recurring throbbing headache, recurring neurologic dysfunction, or both.
What is a significant health risk associated with migraines?
Increased risk for future myocardial infarction (MI) and strokes.
p.28
Tension-Type Headaches
What are the two main types of tension-type headaches?
Episodic TTH (infrequent & frequent) and chronic TTH.
What is a cluster headache?
A type of primary headache characterized by severe, unilateral pain, often around the eye.
How often do cluster headaches occur?
They occur in cyclical patterns or clusters, often multiple times a day during a cluster period.
p.37
Treatment Options for Headaches
What is the dosage range for Topiramate in headache treatment?
50-200 mg PO divided into two doses daily (BID).
p.27
Tension-Type Headaches
What is a tension headache?
A common type of headache characterized by a dull, aching pain and a sensation of tightness or pressure across the forehead or back of the head and neck.
What does the term 'CH' refer to in the context of headaches?
A grouping of headaches occurring over several weeks.
p.28
Pathophysiology of Headaches
What is the pathogenesis of tension-type headaches?
It is complex and multifactorial.
Who is most likely to experience cluster headaches?
They are more common in men than women, typically starting in adulthood.
p.3
Diagnosis of Headaches
What is crucial for the proper management of headaches?
Making an accurate diagnosis.
What are the impacts of headaches on individuals and society?
Significant suffering and economic loss.
p.43
Diagnosis of Headaches
What are the characteristics of pain in trigeminal neuralgia?
Intense, sharp, superficial, or stabbing; or precipitated from trigger areas or by trigger factors.
p.37
Treatment Options for Headaches
What is preventive treatment for headaches?
Treatment aimed at reducing the frequency of headaches, including calcium channel blockers, mood stabilizers, and anticonvulsants.
p.45
Secondary Headaches and Red Flags
What are the intracranial pain-sensitive structures involved in secondary headaches?
Periosteum, cranial nerves, meninges, meningeal arteries and dural sinuses, proximal intracranial arteries, sphenoid sinus, thalamic nuclei, brainstem pain-modulating centers.
p.22
Secondary Headaches and Red Flags
What is a cerebral aneurysm?
A bulge in a blood vessel in the brain that can lead to bleeding.
p.31
Treatment Options for Headaches
What is the typical response for episodic tension-type headaches (ETTH) during a moderate attack?
ETTH generally responds to NSAIDs or analgesics.
What is chronic paroxysmal hemicrania?
A type of headache characterized by recurrent, severe unilateral pain.
What are potential negative outcomes associated with migraines?
Complications of migraine.
What is the typical duration of a cluster headache attack?
Typically lasts from 15 minutes to 3 hours.
What is the nature of pain experienced during a cluster headache?
Excruciating, penetrating, boring, continuous, and non-throbbing.
p.31
Treatment Options for Headaches
Which medications are used for prophylactic treatment of CTTH?
Amitriptyline, SSRIs (like fluoxetine), and other antidepressants.
p.48
Diagnosis of Headaches
What mental and emotional disturbances should be noted in a headache diary?
Mental, cognitive, and mood disturbances.
At what time do cluster headache episodes typically occur?
At the same clock time each day, often around 2 AM.
p.26
Treatment Options for Headaches
What are general measures in the context of headache management?
Lifestyle changes and non-pharmacological strategies.
p.18
Pathophysiology of Headaches
What role does the cerebral cortex, thalamus, or hypothalamus play in headaches?
They respond to stress and emotion, contributing to headache pain.
What activities can trigger pain in some individuals?
Chewing, talking, or smiling.
What types of fluids can trigger pain?
Drinking cold or hot fluids.
p.10
Overview of Headaches
What defines a primary headache?
A headache that is not caused by another underlying disease, trauma, or medical condition.
p.21
Migraine Characteristics and Epidemiology
What triggers a migrainous aura?
Triggers can include stress, certain foods, hormonal changes, and environmental factors.
What are the characteristic qualities of the pain described?
Severe, paroxysmal, and lancinating.
p.14
Tension-Type Headaches
What is a tension headache?
A common type of headache characterized by a dull, aching pain and tightness in the head, neck, or shoulders.
p.48
Diagnosis of Headaches
How should the intensity of pain be rated in a headache diary?
Using a rating scale from 1 to 5.
p.16
Migraine Characteristics and Epidemiology
What type of predisposition is associated with migraines?
Hereditary predisposition.
What are common symptoms of cluster headaches?
Severe pain, tearing, nasal congestion, and restlessness.
p.21
Migraine Characteristics and Epidemiology
How long does a migrainous aura typically last?
Usually lasts between 20 minutes to an hour.
p.45
Secondary Headaches and Red Flags
What are the extra-cranial pain-sensitive structures involved in secondary headaches?
Scalp, scalp muscles, skull, carotid and vertebral arteries, paranasal sinuses, eyes and orbits, mouth, teeth, pharynx, ears, cervical spine and ligaments, cervical muscles.
p.43
Diagnosis of Headaches
What does criterion C state about the attacks in trigeminal neuralgia?
Attacks are stereotyped in the individual patient.
What environmental factor can trigger pain?
Encountering cold air from an open automobile window.
What triggers episodes of trigeminal neuralgia?
Triggers can include light touch, chewing, speaking, or even a breeze.
p.37
Treatment Options for Headaches
What is the typical dosage of Lithium for headache prevention?
300 mg PO taken 2 to 3 times a day (BID to TID).
What are the common symptoms of trigeminal neuralgia?
Sudden, severe, and sharp facial pain, often described as electric shock-like.
p.37
Treatment Options for Headaches
What is the dosage and method for administering Prednisone for headaches?
40-100 mg in a burst followed by tapering.
What are common symptoms associated with cluster headaches?
Severe pain, tearing, nasal congestion, and restlessness.
What psychological symptoms may occur during cluster headache attacks?
A sense of restlessness or agitation.
Who is most likely to experience cluster headaches?
They are more common in men than women, often starting in early adulthood.
p.13
Diagnosis of Headaches
What components are included in a neurologic exam?
Motor, sensory, coordination, and gait assessments.
p.23
Diagnosis of Headaches
Why is it important to rule out comorbid diseases in headache diagnosis?
To avoid complications in headache treatment.
What are the pain-sensitive structures in relation to headaches?
There are many pain-sensitive structures in the head and neck.
p.21
Migraine Characteristics and Epidemiology
What are common symptoms of a migrainous aura?
Visual disturbances, such as flashing lights, zigzag patterns, or temporary loss of vision.
p.3
Secondary Headaches and Red Flags
What should be recognized to manage headaches effectively?
The features of 'dangerous' headaches.
p.21
Migraine Characteristics and Epidemiology
Can a migrainous aura occur without a headache?
Yes, it can occur without a subsequent headache in some individuals.
p.28
Tension-Type Headaches
What is the prevalence of tension-type headaches (TTH) in the general population?
Ranging between 30% and 78% in different studies.
What is a cluster headache?
A type of primary headache characterized by severe, unilateral pain, often around the eye.
p.28
Tension-Type Headaches
What is the socio-economic impact of tension-type headaches?
It has a very high socio-economic impact.
What defines a cluster headache?
A series of relatively short but extremely painful headaches that occur in clusters or cycles.
What happens to the patient's expression during an attack?
It often contorts due to the pain.
What are trigeminal autonomic cephalalgias?
A group of primary headache disorders that include cluster headaches and are characterized by autonomic symptoms.
p.27
Tension-Type Headaches
What are common symptoms of tension headaches?
Dull, aching pain, tightness or pressure in the forehead, temples, or back of the head and neck.
p.31
Treatment Options for Headaches
What additional approaches can be beneficial in headache treatment?
Psychotherapy and lifestyle modification.
p.27
Tension-Type Headaches
What triggers tension headaches?
Stress, poor posture, lack of sleep, and muscle tension.
p.22
Secondary Headaches and Red Flags
What is GCA?
Giant cell arteritis, an inflammation of blood vessels that can cause headaches.
p.22
Secondary Headaches and Red Flags
What is the Tolosa-Hunt syndrome?
A condition characterized by unilateral headache and ocular signs due to inflammation.
p.18
Pathophysiology of Headaches
What is a consequence of abnormal neuronal activity in headaches?
Instability in the release of neuropeptides.
What is the frequency of attacks during an active period of cluster headaches?
Between one every other day and eight per day.
p.46
Secondary Headaches and Red Flags
What can cause a secondary headache due to substance withdrawal?
Withdrawal from drugs or medications.
p.24
Treatment Options for Headaches
What is a key component of non-pharmacologic treatment for headaches?
Self-management education.
p.18
Pathophysiology of Headaches
What do neuropeptides promote that contributes to headaches?
Vasodilation and plasma protein extravasation.
p.22
Secondary Headaches and Red Flags
What does ICH stand for?
Intracerebral hemorrhage, a type of bleeding within the brain.
p.47
Secondary Headaches and Red Flags
What physical symptoms are red flags associated with headaches?
Fever and neck stiffness.
What are some common symptoms associated with cluster headaches?
Watering eyes, nasal stuffiness, runny nose, red eye, swollen eyelids, and sweating.
p.18
Pathophysiology of Headaches
Where do pain-stimulating neurons get activated in response to headaches?
In the brain stem and upper spinal cord.
What physical reactions may patients exhibit during an attack?
Grimacing, wincing, or making aversive head movements.
p.23
Diagnosis of Headaches
What is established during the diagnosis of headaches?
A baseline for treatment and exclusion of contraindications to drug administration.
p.27
Treatment Options for Headaches
What is a common treatment for tension headaches?
Over-the-counter pain relievers, relaxation techniques, and lifestyle changes.
p.46
Secondary Headaches and Red Flags
What types of conditions can lead to headache or facial pain?
Disorders of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cranial structures.
p.24
Treatment Options for Headaches
Why is addressing workplace ergonomics important in headache management?
To reduce strain and potential headache triggers.
p.46
Secondary Headaches and Red Flags
What is a secondary headache attributed to disorders of homeostasis?
A headache caused by imbalances in the body's internal environment.
p.18
Pathophysiology of Headaches
Which neuropeptides are involved in headache pathophysiology?
Substance P, neurokinin A, calcitonin gene-related polypeptide, and serotonin.
What is a typical demographic for cluster headache patients?
Middle-aged male smokers.
p.18
Pathophysiology of Headaches
What initiates the inflammatory response in headaches?
Abnormal neuronal activity and neuropeptide release.
p.46
Secondary Headaches and Red Flags
How can psychiatric disorders relate to secondary headaches?
They can be a contributing factor to the development of headaches.
p.18
Pathophysiology of Headaches
What effect does the activation of the nociceptive trigeminovascular system have?
It causes prolonged pain.
p.24
Treatment Options for Headaches
What should patients identify and avoid to help manage headaches?
Triggers such as tobacco smoke, strong odors, or sprays.
