NURS 5462 Headache New Exam With
Accurate Answers (A+)
Primary headache - ANSWER common and is not a symptom of another medical
condition • Migraine • Tension-type • Cluster
Secondary Headache - ANSWER specific etiologies-and sx depend on these pathologies
Gender differences - ANSWER migraine/tension/Giant Cell Arteritis-more common in
women. Cluster more common in men
Onset over 50 - ANSWER or worsening headache check for underlying neurological
disease, 17% of older adults report frequent headche
Headache Requiring Investigation - ANSWER • Sudden onset of new, severe headache •
Progressively worsening • After exertion, straining, coughing, or sex-suggests inc
ICP-needs CT • With associated symptoms - "worst headache I have ever had" • First
headache occurring after the age of 50 years
Cortical Spreading Depression - ANSWER • Basis of the migraine aura • Cortical
neuronal activity followed by a postictal depression of neuronal firing • CSD can trigger
meningeal pain mechanisms via neurogenic inflammation, vasodilation and plasma
extravasation • Blood barrier is activated—which may explain some of the pain •
Glutamatergic synapses in the cortex are activated
Brain Stem Generator - ANSWER • Meningeal pain mechanisms are activated through
the trigeminovascular pathways • This causes release of inflammatory cytokines,
neuroinflammatory peptides and calcitonin gene-related peptide-this hormone causes
the vasodilation • Peripheral nociceptors are activated-this mechanism is referred to as
peripheral sensitization • When the trigeminal nucleus caudalis and rostral brain
structures are activated-it is known as central sensitization
,Clinical Presentation: Migraine - ANSWER • Migraine without aura • Common migraine •
Most common headache • One sided headache • Pounding/throbbing • Moderate to
severe intensity • Lasts 4-24 hours, May be associated with nausea, vomiting, sensitivity
to light or sound
Clinical Presentation: Migraine (aura) - ANSWER • Aura usually occurs before onset of
headache • Auras usually last seconds, but can last up to 20", patient then gets
headache • "Fortification spectrum" occurs in 10% [Jagged lines similar to stone
fortifications around a fort], • Visual auras can be spots, shimmering bright lights or
visual loss [scotomas] • Sensory auras include tingling, numbness of fingers, motor
disturbances such as hemiparesis or monoparesis and cognitive disorders
"prodrome" to a migraine - ANSWER • Increased irritability, decreased energy, food
cravings • A signal that a headache is coming and may allow patient to use methods to
abort the headache
IHS Criteria for Migraine without Aura - ANSWER A At least 5 attacks fulfilling criteria B
through D B Headache lasting 4-72 hrs. [treated or untreated] C Headache has at least 2
of the following: Unilateral location Pulsating quality Moderate to severe intensity Worse
with walking stairs or physical activity D During headache, at least one of the following:
Nausea, vomiting [or both] Photophobia and/or phonophobia E No evidence of related
organic disease
IHS Criteria for Migraine with Aura - ANSWER A At least 2 attacks fulfilling criterion B: B
At least 3 of the following characteristics: One or more fully reversible aura symptoms
At least 1 aura symptom develops gradually over >4" or 2 or more symptoms occur in
succession No single aura symptoms lasts >60" Headache follows aura with a free
interval of <60" C No evidence of a secondary cause
MgSO4 [with aura] 1-2 grams IV
Clinical Presentation: Tension-Type Headache - ANSWER • Feeling like a tight band is
around head • Nausea/vomiting are not present • Mild to moderate intensity • Can last
minutes to hours • Not increased with physical activity, present most of the day and may
start after patient wakes up [Does not wake patient at night], stress is common trigger,
most common in older adult and Gen pop-78% incidence
, • Chronic tension-type headache - ANSWER similar, but occurs more than 15 days a
month
IHS Criteria for Tension-Type Headache - ANSWER Criteria A At least 10 previous
headaches fulfilling criteria B through D B Headache lasts 30" to 7 days C At least 2 of
the following: Pressing/tightening [nonpulsating] quality Mild to moderate intensity
Bilateral No aggravation by walking stairs or other physical activity D Both of the
following: Absence of nausea and vomiting Absence of photophobia and phonophobia
Clinical Presentation: Cluster - ANSWER • Patient usually awakened at night w/ severe,
unilateral, retro-orbital pain • Headache reaches maximum intensity in 15 minutes, lasts
about 90 minutes, but can last up to 3 hours • Attacks occur several times during the day
• Boring pain, severe, Lacrimation, rhinorrhea and a partial Horner's syndrome can be
seen-ipsilateral
Cluster Headache •Chronic Cluster Headache - ANSWER •Same presentation, but
remission does not last more 14 days • Resistant to treatment •ETOH precipitates
attacks
IHS Society Criteria for Cluster Headache - ANSWER A At least 5 attacks fulfilling
criteria B through D B Severe unilateral orbital, supraorbital and/or temporal pain
lasting 15-180" C Headache associated with one of the following [on the side of the
pain]: Conjunctival injection; Lacrimation Nasal congestion; Rhinorrhea Forehead and
facial sweating Miosis; Ptosis Eyelid edema D Attacks occur one qd up to eight per day
MEDICATION OVERUSE HEADACHE - ANSWER occurs with overuse-even advil for non
headache pain
Patient with tension-type headache - ANSWER often has cervical muscle tightness
Serious signs and symptoms - ANSWER • Headache with stiff neck, fever, malaise,
nausea and vomiting •Presence of aphasia, weakness or decreased coordination, •
Onset after age 50 • Asymmetric pupil response • Diminished DTRs • "Worst headache of
my life" • Personality change • Onset of new/different headache • Onset of headache that
Accurate Answers (A+)
Primary headache - ANSWER common and is not a symptom of another medical
condition • Migraine • Tension-type • Cluster
Secondary Headache - ANSWER specific etiologies-and sx depend on these pathologies
Gender differences - ANSWER migraine/tension/Giant Cell Arteritis-more common in
women. Cluster more common in men
Onset over 50 - ANSWER or worsening headache check for underlying neurological
disease, 17% of older adults report frequent headche
Headache Requiring Investigation - ANSWER • Sudden onset of new, severe headache •
Progressively worsening • After exertion, straining, coughing, or sex-suggests inc
ICP-needs CT • With associated symptoms - "worst headache I have ever had" • First
headache occurring after the age of 50 years
Cortical Spreading Depression - ANSWER • Basis of the migraine aura • Cortical
neuronal activity followed by a postictal depression of neuronal firing • CSD can trigger
meningeal pain mechanisms via neurogenic inflammation, vasodilation and plasma
extravasation • Blood barrier is activated—which may explain some of the pain •
Glutamatergic synapses in the cortex are activated
Brain Stem Generator - ANSWER • Meningeal pain mechanisms are activated through
the trigeminovascular pathways • This causes release of inflammatory cytokines,
neuroinflammatory peptides and calcitonin gene-related peptide-this hormone causes
the vasodilation • Peripheral nociceptors are activated-this mechanism is referred to as
peripheral sensitization • When the trigeminal nucleus caudalis and rostral brain
structures are activated-it is known as central sensitization
,Clinical Presentation: Migraine - ANSWER • Migraine without aura • Common migraine •
Most common headache • One sided headache • Pounding/throbbing • Moderate to
severe intensity • Lasts 4-24 hours, May be associated with nausea, vomiting, sensitivity
to light or sound
Clinical Presentation: Migraine (aura) - ANSWER • Aura usually occurs before onset of
headache • Auras usually last seconds, but can last up to 20", patient then gets
headache • "Fortification spectrum" occurs in 10% [Jagged lines similar to stone
fortifications around a fort], • Visual auras can be spots, shimmering bright lights or
visual loss [scotomas] • Sensory auras include tingling, numbness of fingers, motor
disturbances such as hemiparesis or monoparesis and cognitive disorders
"prodrome" to a migraine - ANSWER • Increased irritability, decreased energy, food
cravings • A signal that a headache is coming and may allow patient to use methods to
abort the headache
IHS Criteria for Migraine without Aura - ANSWER A At least 5 attacks fulfilling criteria B
through D B Headache lasting 4-72 hrs. [treated or untreated] C Headache has at least 2
of the following: Unilateral location Pulsating quality Moderate to severe intensity Worse
with walking stairs or physical activity D During headache, at least one of the following:
Nausea, vomiting [or both] Photophobia and/or phonophobia E No evidence of related
organic disease
IHS Criteria for Migraine with Aura - ANSWER A At least 2 attacks fulfilling criterion B: B
At least 3 of the following characteristics: One or more fully reversible aura symptoms
At least 1 aura symptom develops gradually over >4" or 2 or more symptoms occur in
succession No single aura symptoms lasts >60" Headache follows aura with a free
interval of <60" C No evidence of a secondary cause
MgSO4 [with aura] 1-2 grams IV
Clinical Presentation: Tension-Type Headache - ANSWER • Feeling like a tight band is
around head • Nausea/vomiting are not present • Mild to moderate intensity • Can last
minutes to hours • Not increased with physical activity, present most of the day and may
start after patient wakes up [Does not wake patient at night], stress is common trigger,
most common in older adult and Gen pop-78% incidence
, • Chronic tension-type headache - ANSWER similar, but occurs more than 15 days a
month
IHS Criteria for Tension-Type Headache - ANSWER Criteria A At least 10 previous
headaches fulfilling criteria B through D B Headache lasts 30" to 7 days C At least 2 of
the following: Pressing/tightening [nonpulsating] quality Mild to moderate intensity
Bilateral No aggravation by walking stairs or other physical activity D Both of the
following: Absence of nausea and vomiting Absence of photophobia and phonophobia
Clinical Presentation: Cluster - ANSWER • Patient usually awakened at night w/ severe,
unilateral, retro-orbital pain • Headache reaches maximum intensity in 15 minutes, lasts
about 90 minutes, but can last up to 3 hours • Attacks occur several times during the day
• Boring pain, severe, Lacrimation, rhinorrhea and a partial Horner's syndrome can be
seen-ipsilateral
Cluster Headache •Chronic Cluster Headache - ANSWER •Same presentation, but
remission does not last more 14 days • Resistant to treatment •ETOH precipitates
attacks
IHS Society Criteria for Cluster Headache - ANSWER A At least 5 attacks fulfilling
criteria B through D B Severe unilateral orbital, supraorbital and/or temporal pain
lasting 15-180" C Headache associated with one of the following [on the side of the
pain]: Conjunctival injection; Lacrimation Nasal congestion; Rhinorrhea Forehead and
facial sweating Miosis; Ptosis Eyelid edema D Attacks occur one qd up to eight per day
MEDICATION OVERUSE HEADACHE - ANSWER occurs with overuse-even advil for non
headache pain
Patient with tension-type headache - ANSWER often has cervical muscle tightness
Serious signs and symptoms - ANSWER • Headache with stiff neck, fever, malaise,
nausea and vomiting •Presence of aphasia, weakness or decreased coordination, •
Onset after age 50 • Asymmetric pupil response • Diminished DTRs • "Worst headache of
my life" • Personality change • Onset of new/different headache • Onset of headache that
