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CMED 311 > Trans 079: HEADACHE > Flashcards

Trans 079: HEADACHE Flashcards

1
Q

what are the headache red flag?

A 
• Systemic symptoms
• Neurologic symptoms and signs
• Older age of onset >50 years old
• Onset that is thunderclap (sudden/severe)
• P5
o Pattern change
o Progressive
o Positional
o Precipitation with Valsalva
o Pregnancy

SNOOP5

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2
Q

is the most important part of the exam for

headache

A

Cranial nerve is the most important part of the exam for

headache

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3
Q

potential Giant Cell Arteritis or Temporal

Neuritis. The first step is to identify

A

ESR

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4
Q

Systemic inflammatory vasculitis (large and medium
arteries)
 Temporal artery and posterior ciliary artery of the eye

A

Giant Cell Arteritis

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5
Q

giant cell arteritis common in male or female? age?

A
  • Typically older (>50 y/o)

- Female>male

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6
Q

Some manifestation of Giant cell arteritis?

A
  • Headache (90%) and scalp tenderness
  • Jaw and tongue claudication (50%)
     When they chew, there is progressive pain
  • Polymyalgia rheumatica (50%)
     Generalized aching of proximal limb muscles
  • Fever and malaise
  • Visual symptoms/loss (Posterior ciliary artery occlusion)
     Blindness is usually permanent
  • Aortic dissection
     If it goes untreated
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7
Q

Screening test Giant cell arteritis?

A

ESR, CRP, Temporal Artery Biopsy

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8
Q

Tx Giant cell arteritis?

A

Steroids

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9
Q

when to use imaging in headache?

A

if there is a concern for secondary cause, or red flag

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10
Q

preferred imaging for emergency?

A

CT

o MRI>CT head non-emergent/ if available
o MRA/CTA: for all thunderclap headache

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11
Q
  • Severe head pain reaching maximum intensity <1 minute

- Lasting greater than or equal to 5 minutes

A

Thunderclap headache

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12
Q

most common brain tumor type is? and the most common cause of metastatic origin is ?

A

metastatic; lung

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13
Q

what type of edema is happening in stroke?

A

Cytotoxic edema

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14
Q

Normal opening pressure is

A

Normal opening pressure is between 10-25

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15
Q

presenting symptom of TB meningitis?

A
  • Low grade fever, malaise, weight loss, gradual onset HA
  • 50% increased ICP
  • May have focal neurologic deficits (CN Palsy)
  • Seizure common <18 y/o
     More common presenting symptom
  • CSF findings
  • Pleocytosis with lymphocytic predominance
  • Decreased glucose (<50%)
  • Increased protein
  • AFB smear (MTB-PCR if available)
  • Evaluate for HIV
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16
Q

if there is viral meningitis, what should be given immediately?

A

Acyclovir

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17
Q

Most common causes of viral meningitis?

A

Enteroviruses»Arbovirus>Herpesvirus>HIV

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18
Q

findings in bacterial meningitis?

A
  • Strong Predictor
  • Glucose <34mg/dl
  • CSF to serum glucose ratio <0.23
  • Protein >220 mg/dl
  • Total pleocytosis >2000cells/microL
  • PMN >1180 cells/microL
  • LIFE THREATENING
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19
Q
  • Occurring within 20 seconds, peaking in 1 minute
  • Nonspecific features, may include vertigo, tinnitus, diplopia
  • Rarely cranial nerve changes and cortical blindness
  • 90% within 24 hours, rarely 5-14 days

whta type of headache?

A

Positional headache

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20
Q

post lumbar puncture headache? age? sex? RF?

A

• High risk: age 20-30s (16%), 50s (4%), >60 rare

- F > M, lower BMI, chronic headaches, technique/nee

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21
Q

• 24 F present with headache and episodes of “graying out” of her vision

  • Holocephalic, occipital > frontal
  • Pulsating, worse in morning
  • Associated with nausea, neck stiffness, photophobia
  • Coughing results in visual change
  • Several months duration
A

intracranial hypertension

22
Q

waht drug decreases CSF produciton?

A

Acetazolamide

23
Q

• 18 F presents a 3yr history of severe HA (headache) once per month.
- Over 1 hour develops severe L>R pulsatile pain
 the headache develops over 1 hour. Described as a severe pulsatile pain. It hurts on both sides of the head but more so on the left
- Nausea, sometimes vomiting
- Photophobia and phonophobia
 Sensitivity to light and sound, also with smell at times
- Often will have some forehead pressure with nasal congestion during episode
- Worse with activity, prefers to be in a quiet, dark room
- Lasts 8-12 hours
- No menstrual association
- Exam: Normal

what case?

A

Migraine

24
Q

which is more common in migraine, photophobia or phonophobia?

A

photophobia more common

25
Q

Simple, accurate, fast screener for migraine – strongest predictors of migraine diagnosis

A

• Photophobia – Does light bother you when you have headache?
• Impairment (Disability) – Has a headache limited your activities for a day or more in the last 3 months?
• Nausea – Are you nauseated or sick to your stomach when you have a headache?
o 2 out of 3 symptoms : 93 positive predictive value
o 3 out of 3 symptoms : 98 positive predictive value
 These are very predictive of migraine

26
Q

Migraine prevalence peak at what age, gender?

A

o Prevalence peaks at 25-55 years of age
o “Our most productive years
o Female > male 3:1

27
Q

a secondary symptom, occurring simultaneously with a disease or condition not directly related to it.

A

epiphenomenon

28
Q

an inherited neurological disorder characterized by neurological, sensory, autonomic, vestibular, cognitive, and gastrointestinal symptoms.

A

migraine

29
Q

o Bilateral location
o Pressing/ tightening (non-pulsatile) quality
o Mild to moderate
 not usually very bad
o Not aggravated by activity
• No nausea/ vomiting
• Either photophobia or phonophobia – “not both, not usually significant
 Again, mild to moderate and not associated with nausea – that is tension headache
• Good history is key

what case?

A

Tension headache

30
Q

is the most common headache disorder in the world

Rarely treated by a physician

A

tension headache

31
Q

• A headache present on > or = 15 days / month with a prior headache disorder.
• Regular overuse for >3 month of one or more acute medications
o 10 days/month for most meds, 15 days/month for simple analgesics
• Headache has developed or markedly worsen during medication overuse

A

Medication Overuse Headache (MOH)

32
Q

Don’t take triptans more than ______ times a week

A

3

33
Q

is an old barbiturate and has been gradually been used less and less because of this issue.

A

butalbital

34
Q

Migraine Preventive Therapy: Goals

A
  • Reduce attack frequency, severity, and duration
  • Reduce acute medication use and potential for MOH
  • Improve responsiveness to treatment of acute attacks
  • Improve function and reduce disability
35
Q

lifestyle modifications for migraine?

A

SEEDS:

o Sleep hygiene
o Exercise daily
 Exercising daily is helpful. Exercise during an attack is not helpful, it can make the pain worse. You want them to have a routine where most days of the week they are doing regular exercise if possible
o Eat regular meals
 Avoiding fasting is important for people with migraine
o Diary of headaches
 You can get a sense if the lifestyle recommendation that you’ve given them are helping
o Stress reduction
 or addressing depression and anxiety are also important in preventing migraine

36
Q

Supplements that can be taken for migraine?

A 
o Magnesium 400mg BID (Level B)
o Riboflavin (Vit B2) 200mg BID (Level B)
o Avoid Butterbur (Petasites) – concerns for hepatotoxicity
 has shown to be helpful for migraine in some studies but unfortunately, if you don’t process this particular supplement right, it causes a hepatotoxic metabolite so we stopped recommending this particular supplement but I know its still out there and its worth knowing that it has its potential complication
37
Q

In terms of medication approaches, we usually think about medicine anytime when the headache is getting more than weekly (greater than___a month) or more than____ days a month

A

4;

8

38
Q

anti seizure meds for headache that can cause weight loss?

A

Topiramate

39
Q

when do you say that it is a chronic migraine already?

oftentimes called Chronic Daily Headache

A

Headache for >15 days/ month, for at least 3 months

• For > 8 days/month, for at least 3 months, headache fulfills criteria for migraine without aura

40
Q

The most common aura is

A

The most common aura is visual

People see bright flashing light, things like arc or a dark spot, that then gradually encompasses their vision. It could be off to just one side of the visual field or sometimes spread to the other side. But the key is it should only last less than an hour, on average, it’s about 20minutes and it has to be at least 5 mins. So it’s not something that’s very brief. Its long enough to get your attention.

41
Q

aura should last for how long?

A

> 5 mins but <60 mins

42
Q

are neuropeptides implicated in migraine. This is actually what’s triggering the pain.

A

Serotonin receptors 1B/1D and CGRP

43
Q

Vasoconstrictive agents for acute tx of migainre

A

▪ Triptans (5HT 1B/1D receptor agonists)

▪ Ergotamines

44
Q

non vasoconstrictive agents for acute tx of migainre

A

Ditans (5HT 1F receptor agonists)

Gepants (“CGRP antagonists)

45
Q

contraindications of triptans?

A

o Prinzmetal’s angina
o High risk for cardiovascular disease (“they had MI, stent)
o Uncontrolled hypertension
o Cerebrovascular disease (“they had stroke)
o Basilar / hemorrhagic migraine

46
Q

classic triad of serotonin syndrome?

A

dysfunction, dysautonomia, and mental status changes

47
Q

• At least 5 attacks
• Severe or very severe unilateral, orbital, supraorbital, and/or temporal pain lasting 15-180mins
 Shorter than a migraine. It lasts about 30mins to 2 hours. And then it will completely go away, and then it will occur in the same day, often in the same time

what case?

A

Cluster headache

48
Q

ipsilateral cranial autonomic feature in cluster headache?

A 
o Conjunctival injection and/or lacrimation
o Nasal congestion and/or rhinorrhea
o Eyelid edema
o Forehead and facial sweating
o Forehead and facial flushing
o Miosis and/or ptosis
o A sensation of fullness in the ear
49
Q

aka suicide headache?>

A

cluster headache

50
Q

a Ca channel blocker, is a common cluster headache preventative

A

verapamil

CMED 311 (47 decks)

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