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Headache in Palliative Care

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Essentials of Palliative Care

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Abstract

Headaches comprise a relatively common pain condition, with etiologies ranging from benign to life-threatening. The International Headache Society categorizes headaches into primary, such as migraine, cluster or tension, and secondary, such as due to underlying infection, neoplasm or other disease process. It is crucial to recognize life-threatening causes, as well as to identify benign but incapacitating etiologies. This chapter focuses on the differential diagnosis for refractory headache patients, with particular emphasis on two of the most common and disabling headache disorders, migraine and cluster headache.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Naval Medical Center San Diego, San Diego, CA, USA

    Nicholas Connolly M.D. & Matthew Peña M.D.

  2. Department of Anesthesiology, Naval Medical Center San Diego, Bethesda, MD, USA

    Tara M. Sheridan M.D.

Authors
  1. Nicholas Connolly M.D.
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  2. Matthew Peña M.D.
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  3. Tara M. Sheridan M.D.
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Corresponding author

Correspondence to Tara M. Sheridan M.D. .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Yale University, New Haven, 06520, Connecticut, USA

    Nalini Vadivelu

  2. Citrus Road 278, River Ridge, 70123, Louisiana, USA

    Alan David Kaye

  3. Keck School of Medicine, Department of Anesthesiology, Pain Medic, of the University of Southern California, Los Angeles, 90035, California, USA

    Jack M. Berger

Appendices

Review Questions

  1. 1.

    What percentage of migraineurs experience aura?

    1. (a)

      Less than 10%

    2. (b)

      15–20%

    3. (c)

      40–50%

    4. (d)

      More than 80%

  2. 2.

    Common migraine triggers include all of the following except

    1. (a)

      Abrupt changes in sleep patterns

    2. (b)

      Hormonal fluctuations associated with the menstrual cycle

    3. (c)

      Sinus congestion associated with seasonal allergies

    4. (d)

      Tyramine containing foods, such as aged cheese and red wine

  3. 3.

    Which of the following is not a phase of the common migraine?

    1. (a)

      Prodrome

    2. (b)

      Aura

    3. (c)

      Headache

    4. (d)

      Postdrome

  4. 4.

    Which of the following treatments would be the least effective abortive agent for a cluster headache attack?

    1. (a)

      Sumatriptan 6 mg subcutaneous

    2. (b)

      Oxygen 12 L/min via nonrebreather mask

    3. (c)

      Lidocaine 4% intranasal spray

    4. (d)

      Verapamil 300 mg PO

  5. 5.

    A 33-year-old male patient with a past medical history significant only for episodic cluster headaches has been taking sumatriptan 6 mg subcutaneously twice daily over the past 2 weeks with partial relief of cluster headaches that occur 4–6 times daily. Which of the following would be the most appropriate next step in his treatment?

    1. (a)

      Deep brain stimulation of the posterior hypothalamus

    2. (b)

      Start dihydroergonovine 1 mg IM BID in addition to continuing his current therapy

    3. (c)

      Increase frequency of subcutaneous sumatriptan to three or four times daily

    4. (d)

      PO prednisone taper in addition to his current therapy

Answers

  1. 1.

    (b)

  2. 2.

    (c)

  3. 3.

    (b)

  4. 4.

    (d)

  5. 5.

    (d)

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Connolly, N., Peña, M., Sheridan, T.M. (2013). Headache in Palliative Care. In: Vadivelu, N., Kaye, A., Berger, J. (eds) Essentials of Palliative Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5164-8_18

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  • DOI: https://doi.org/10.1007/978-1-4614-5164-8_18

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