Type Migraine 1o HEADACHES

PHYSIOLOGY +/- aura craniocervical muscle spasm *thought to be related to pressure on trigeminal nerve

QUALITY throbbing, aching pressing or tightening deep, continuous, severe

TRIGGERS TIMING preservatives, nitrates, stress, N/V, photophobia, rapid onset, caffeine, missing meals, sleep usually unilateral phonophobia, sensory & motor quiet, dark, sleep peaks in 1-2 patterns, aged cheeses, auras hrs beers, wine, certain foods. usually bilateral photophobia, phonophobia relaxation, massage varies driving, typing, studying alcohol

LOCATION

ASSOC s/s

PALLIATE

DURATION > 72 hrs

TX Abortive/Analgesic; Prophylactic; rest, neck massage

Tension Cluster acute glaucoma

gradual onset minutes --> days

unilateral (behind ptosis, lacrimation, rhinorrhea, or around the miosis, eyelid edema, eye) conjunctival injection halos around obects, fixed and dilated pupil, ciliary injection (flush)

hours; episodic abrupt onset in clusters, then supplemental oxygen helps remission

steady, aching & deep in and severe around the eye aching, inflammation of the throbbing (facial nasal mucosa pain/ tenderness)

rest

Sinus HA

above eye or cheek

tenderness, nasal congestion & d/c, fever

decongestants, antibiotics

coughing, sneezing, lowering onset variable the head (anyting that (usually ~day 8 increases intracranial of URI) pressure)

Improve sinus drainage (tx underlying cause)

Subarachnoid intracranial bleeding severe "worst Hemorrhage due to aneurysm HA of my life"

generalized

n/v, LOC, neck pain scalp tenderness, fever, fatigue, wt loss, jaw claudication, polymyalgia rheumatica, visual loss, blindness Anhedonia (always present); anger & feelings of being trapped; +/- back pain

Temporal Arteritis 2o HEADACHES

usually temporal immune response to artery, but severe throbbing lining of artery anywhere along carotid Depression hurts Dull

none

movement of neck & shoulders

gradual or rapid

variable

Prednisone 100mg ASAP + Opthalm referral

Depression HA Drug Rebound HA Trigeminal Neuralgia Post-Traumatic HA

Continuous

Daily

Antidepressants

Unilateral

Unilateral

Tic appearance.

Continuous

Repetritive 1-2 wks posttrauma

Increased ICP Pseudotumor (usually young Cerebri aka BIH woman, tetracycles, BCP) Hydocephalus CT/MRI reveals dilated ventricles (increased ICP)

Frontal (but can be anywhere)

+/- CN palsies; Visual disturbances;

Lumbar puncture (decreases ICP)

Worse in AM.

Persistent & progressive.

LP (relieve pressure); Diuretic (Acetozolamide); place shunt if all else fails.

TYPES OF VERTIGO Peripheral Vertigo: Benign Positional Peripheral Vertigo: Acute labyrinthitis

PHYSIOLOGY theory is that crystals w/in ear have become un-aligned

QUALITY sudden on set of dizziness when moving head

ASSOCIATED FX nystagmus & sometimes N/V (no neurological symptoms or hearing loss) N/V, hearing loss & tinnitis, nystagmus

TRIGGERS head movements

TIMING sudden onset sudden onset; lasts hours to weeks

TX apply's maneuver

associated with recent URI

Central Vertigo

due to a central brainstem lesion (TIA, MS, tumors, etc)

typically associated with neurological defects (i.e. dysarthria & ataxia)

sudden onset