Headaches. How many times have you heard
somebody say, oh, I've got a migraine?
Do they really? Do they know how debilitating a
migraine is? Do they know the definition of a
migraine? Which leads me to the
differential diagnosis of different types of headaches.
You've got cluster tension and migraines.
Wait a minute, differential diagnosis?
What type of a question am I going with here?
Case study matrix grid 100% patient presents with dot, dot,
dot signs and symptoms. When people say I've got a
migraine and they're able to say I've got a migraine and they're
sitting there doing one of these, they don't have a
migraine. What they've got is a tension
headache. So what are some risk factors?
Risk factors select all apply of tension headaches.
So things like sinus issues, dehydration, stress, caffeine
withdrawal, so on and so forth. So again, these are things that
can be resolved. So how do I treat it?
Well, treat the underlying 'cause you got stress, get rid
of the stress. You got caffeine withdrawals.
Well, tough it out so you don't have them anymore.
Or give yourself some caffeine. So dehydrated, drink some
fluids. Tension headaches are going to
be something that's bilateral. They're probably going to last
about 30 minutes to about four hours.
That's your time frame, but treat the underlying cause and
it's going to feel like a band around your head, like
somebody's putting pressure all around your head.
And how are we going to treat it?
Well and said acetaminophen analgesics, right?
So ultimately treat the underlying cause.
And if you need something a little bit more, we've got some
pharmacological intervention there.
So your basic care and comfort for this individual is going to
be treat the underlying cause, hydrate, caffeine, so on so
forth, relieve stress, rest, or we can give them NSAIDs,
acetaminophen. The next one is what we call a
cluster headache. A cluster headache is typically
going to be seen in males and it's going to be unilateral and
it's going to be around the eye and it's going to be a sharp
pain that happens at the same time every single day.
This one lasts 15 minutes to three hours.
And with this we can use one of our triptan drugs, so something
like Sumatriptan. So cluster headaches, again, a
differential diagnosis between tension, which is going to be
your more common one when people are like, oh, I have a migraine.
No, you don't, you've got a tension headache.
Cluster more significant seen in males and again same time around
the eye 15 to 15 minutes to three hours.
But we need to treat this with Sumatriptan.
Now we get to what is a migraine, what people think
they're having but they're really not unless they truly
know. When you've had a migraine,
typically you've had a history of it and it's recurring or it
can be triggered. So migraines are debilitating.
People don't understand how sensitive you become to sound
and light. So photophobia, phonophobia,
it's going to be unilateral and it's going to last four hours up
to three days, 72 hours. This person's going to want to
sit in a dark room, a dark, quiet room.
So those of you that have ever had a migraine, which I haven't,
but I've treated patients with it, they're not going to want to
leave that dark room. And in this situation, again,
our option pharmacologically is going to be Sumatriptan.
We can also use acetaminophen and SEDS simultaneously.
But with the farm portion of this, what we want to know is
that we can prophylactically treat this.
So once a person gets a migraine, we know that they're
going to get it again. It's just inevitable at some
point they're going to get triggered or it's just going to
happen. And now we want to
prophylactically prevent it. And what's a great drug, a
cardiac drug you wouldn't think is used for neuro, but a cardiac
drug that we can use prophylactically for that
migraine? Beta blockers.
So beta blockers prophylactically, like a
Propranolol, metoprolol, atenolol, you can give it
prophylactically in order to prevent migraines from
happening. So when we think about beta
blockers, what are we thinking? Bronchoconstriction
contraindication, Bronchospasm contraindication.
So what? COPD, asthma.
And remember, beta blockers do what they lower blood pressure,
lower your heart rate. Even though we're using the
prophylactically for migraines, but know what they really do.
So if we give too much of it, look for them to become
hypotensive and bradycardic. So side effects of beta
blockers, never forget those because beta blockers are super,
super high yield. And again, we can use a
prophylactically for migraines. So the differential diagnosis
here is cluster unilateral, same time typically in males treated
with Sumatriptan tension, which is typically what we talk about
when people are like, oh, I got a migraine.
And these ones are going to be things like stress, dehydration,
caffeine withdrawal, so on and so forth.
And what are we going to do? Treat the underlying 'cause if
we need, we can give analgesics. And then the last one is an
actual migraine, which is debilitating, 4 hours to three
days, photophobia, phonophobia, meaning I don't like light, I
don't like sound. And we're going to treat them
with Sumatriptan and SEDS, acetaminophen and
apophylactically we can give them beta blockers.
So know those differential diagnosis.
It's a great bow tie question, a great case study or a great
select all to apply. I mean, I can ask it in 100
different ways. So know those inside out because
they're super high yield. Why they're common, Common
medical conditions are high yield.
So again, super high yield. Hope you enjoyed.