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NMSP Exam 1 > Clinical Approach to Headache > Flashcards

Clinical Approach to Headache Flashcards

1
Q

What is needed for headache history?

A
  • Good general health history
  • Headache history –> Types, frequency
  • Pain –> intensity/quality, location, duration, impact of exertion
  • Prodrome
  • Associated symptoms
  • Behavior –> retreats to dark, quiet room, paces, rocks
  • Triggers
  • Current or previous medications tried
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2
Q

What are some prodromes that may be seen in headaches?

A
  • Change in energy levels, mood, appetite
  • Fatigue
  • Muscle aches
  • Aura
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3
Q

What is needed in the medical or surgical history when looking into headaches?

A
  • Comorbidities –> sleep disturbances and mood disturbances
  • Other medications
  • Head trauma
  • Previous LOC
  • Seizure disorders
  • Allergies
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4
Q

What is needed about family/social history when looking into headaches?

A
  • Family illnesses, including headaches
  • Habits –> smoking, alcohol, other drugs
  • Occupation
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5
Q

What should be part of the physical exam when looking into headaches?

A
  • Vital signs –> particularly BP/pulse
  • Cardiac status
  • Extracranial structures
  • ROM and presence of pain in C-spine
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6
Q

What should be included in the neurological exam for headaches?

A
  • Neck flexion
  • Presence of bruits over the head and neck
  • Optic fundi, pupils, visual fields
  • Thorough cranial nerve exam
  • Motor power in limbs
  • Muscle reflexes
  • Plantar responses
  • Sensory exam
  • Coordination
  • Gait
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7
Q

What are some worrisome signs in a headache?

A
  • Worst headache
  • Onset of headaches after age 50
  • Atypical headache for patient
  • Headache with fever
  • Abrupt onset
  • Subacute headache with progressive worsening over time
  • Drowsiness, confusion, memory impairment
  • Weakness, ataxia, loss of coordination
  • Paresthesias/sensory loss/paralysis
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8
Q

What is meningitis?

A
  • Inflammation of the meninges surrounding brain and spinal cord, sometimes with associated encephalitis
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9
Q

What is the most common cause of meningitis in adults, infants, and young children?

A
  • Strep pneumoniae
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10
Q

What is the most highly contagious cause of meningitis?

A
  • N. meningitidis

- Seen in young adults and teenagers

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11
Q

What are some complications of bacterial meningitis?

A
  • Hearing loss
  • Memory difficulty
  • Learning disabilities
  • Brain damage
  • Gait problems
  • Seizures
  • Kidney failure
  • Shock or death
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12
Q

What are the symptoms of meningitis in people over 2 years old?

A
  • Sudden high fever
  • Stiff neck
  • Severe headache that seems different than normal
  • Headache with N/V
  • Confusion or difficulty concentrating
  • Seizures
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13
Q

What are the signs of meningitis in newborns?

A
  • High fever
  • Constant crying
  • Excessive sleepiness or irritability
  • Inactivity or sluggishness
  • Poor feeding
  • Bulge in the soft spot on top of baby’s head
  • Stiffness in a baby’s body and neck
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14
Q

What should be given to infants and children with bacterial meningitis?

A
  • Empirical antibiotics and steroids which helps prevent from long term complications
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15
Q

What does CSF look like in bacterial meningitis?

A
  • Opening pressure –> elevated
  • WBC –> ≥1000 per mm3
  • Cell differential –> PMNs
  • Protein –> mild to moderate elevation
  • Glucose –> normal to marked decrease
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16
Q

What does CSF look like in viral meningitis?

A
  • Opening pressure –> normal
  • WBC –> <100 per mm3
  • Cell differential –> Lymphocytes
  • Protein –> normal to elevated
  • Glucose –> normal
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17
Q

What does CSF look like in fungal meningitis?

A
  • Opening pressure –> variable
  • WBC –> variable
  • Cell differential –> lymphocytes
  • Protein –> elevated
  • Glucose –> low
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18
Q

What are some common causes of infectious encephalitis?

A
  • HSV 1 or HSV 2
  • West Nile
  • Varicella Zoster
  • Treponema pallidum
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19
Q

What are some causes of infectious encephalitis in neonates?

A
  • HSV2
  • CMV
  • Rubella
  • Listeria
  • Treponema
  • Toxoplasma
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20
Q

How does HSV 1 encephalitis present?

A
  • Rapidly progressive neurologically devastating illness with combination of fever, headache, impaired consciousness, seizures, and focal neurologic symptoms
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21
Q

What do MRI and EEG show in HSV1 encephalitis?

A
  • Focal abnormalities in temporal lobes
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22
Q

What is the treatment for HSV1 encephalitis?

A
  • Acyclovir
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23
Q

What can happen do people who recover from HSV 1 encephalitis?

A
  • Could develop recurrent neuropsychiatric symptoms sometimes associated autoantibodies with secondary autoimmune encephalitis
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24
Q

What are some treatment options for autoimmune encephalitis?

A
  • High dose steroids
  • IVIG
  • Plasma exchange
  • Rituximab
  • Cyclophosphamide
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25
Q

Who is affected by NMDA encephalitis?

A
  • Young or middle aged women
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26
Q

How does NMDA encephalitis present?

A
  • Abnormal psychiatric behavior or cognitive dysfunction
  • Speech dysfunction
  • Seizures
  • Movement disorders, dyskinesias, or rigidity/abnormal postures
  • Decreased LOC
  • Autonomic dysfunction or central hypoventilation
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27
Q

What is seen on laboratory study in NMDA encephalitis?

A
  • Abnormal EEG –> extreme delta brush (diagnostic)

- CSF with pleocytosis or oligoclonal bands and/or NMDA receptor antibodies

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28
Q

What is associated with NMDA encephalitis?

A
  • Presence of teratoma
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29
Q

What can happen with treatment in NDMA encephalitis?

A
  • Many will improve with aggressive treatment
30
Q

Who is affected most by LGI1 encephalitis?

A
  • Men
31
Q

How does LGI1 encephalitis present?

A
  • Faciobrachial dystonic seizures –> brief seizures involving one side of the face and arm of same side that occur frequently
  • Sleep disturbances
  • Temporal lobe (hippocampus) abnormality present
32
Q

What is the intensity of common migraine?

A
  • Moderate to severe
33
Q

What disability is seen in common migraines?

A
  • Inhibits or prohibits daily activities

- Pain aggravated by activity

34
Q

Who is most commonly affected by common migraines? What age?

A
  • Females in their late teens to early 20s

- Prevalence peaks between 35-40 years old

35
Q

What is the frequency and duration of common migraines?

A
  • 1-4 attacks per month

- 4 to 72 hour duration –> usually 12 to 24 hours

36
Q

Where are common migraines located? How are they described?

A
  • Unilateral or bilateral

- Described as throbbing/sharp/pressure

37
Q

What is the prodrome seen in common migraines?

A
  • Mood changes
  • Myalgias
  • Food cravings
  • Sluggishness
  • Excessive yawning
38
Q

What is the postdrome seen in common migraines?

A
  • Fatigue
  • Irritability
  • “Fog”q
39
Q

Is there an aura with common migraines?

A
  • NO
40
Q

What are the most common associated symptoms of common migraines?

A
  • N/V
  • Photophobia
  • Phonophobia
41
Q

How does classic migraine differ from common migraine?

A
  • Classic migraines have an aura
42
Q

What is an aura?

A
  • Usually lasts 15-30 min

- Commonly visual symptoms (scintillations, scotoma - often hemianopic) but can be anything neurological

43
Q

What are chronic migraines?

A
  • Headaches consistent with migraine, now with headache 15 or more days per month, headache lasting 4 hours or longer, for a period of at least 3 months
44
Q

What causes migraines?

A
  • Not really for sure

- One theory is that they could be caused by neurogenic inflammation

45
Q

What is the intensity and disability of a tension type headache?

A
  • Intensity: mild to moderate

- Disability: May inhibit, but does not prohibit daily activities

46
Q

Who is most affected by tension type headaches?

A
  • Variable age, generally peak incidence at 20-40 years old

- More in females

47
Q

What is the frequency of tension type headaches?

A
  • Episodic type –> <15 days

- Chronic type –> >15 days

48
Q

What is the duration of tension type headaches?

A
  • Episodic type –> several hours

- Chronic type –> all day, waxing and waning

49
Q

What is the location and description of tension type headaches?

A
  • Bifrontal, bioccipital, neck, shoulders, band like

- Described as a dull, aching, squeezing pressure

50
Q

Do tension type headaches have an aura?

A
  • NO
51
Q

What is the intensity and disability of cluster headaches?

A
  • Severe and excruciating

- Prohibits daily activities

52
Q

Who is most affected by cluster headaches?

A
  • More in males in their 20s-50s
53
Q

What is a big association of cluster headaches?

A
  • Obstructive sleep apnea
54
Q

What is the monthly frequency of cluster headaches?

A
  • Episodic type –> 1 or more attacks a day for 6-8 weeks

- Chronic type –> several attacks per week without remission

55
Q

What is the duration and location of cluster headaches?

A
  • 30 min to 2 hours

- 100% unilateral –> generally orbitotemporal

56
Q

What is the description and prodrome of cluster headaches?

A
  • Non Throbbing, excruciating, shapr, boring, penetrating

- Prodrome may include brief mild burning in ipsilateral inner canthus or internal nares

57
Q

What is the behavior of someone with cluster headaches?

A
  • Frenetic
  • Pacing
  • Rocking
58
Q

What are some associated symptoms of cluster headaches?

A
  • Ipsilateral ptosis
  • Miosis
  • Conjunctival injection
  • Lacrimation
  • Stuffed or runny nose
59
Q

What are some headache triggers?

A
  • Hormones –> menses, ovulation, HRT, OCPs
  • Diet –> alcohol, chocolate, aged cheeses, MSG, aspartame, caffeine, nuts,
  • Changes in weather, altitude, seasons, travel
  • Stress
  • Sensory stimuli –> bright or flickering lights, odors
60
Q

What are some treatment options for migraines?

A
  • OTC analgesics
  • NSAIDs
  • Isometheptene
  • Butalbital
  • Opioids
  • DHE nasal spray
  • Triptans
61
Q

What is a contraindication to triptan use?

A
  • Ischemic heart disease
  • Cerebrovascular or peripheral vascular disease
  • Raynaud’s
  • Uncontrolled HTN
  • Hemiplegic or basilar migraine
  • Severe renal or hepatic impairment
  • Use within 24 hr of treatment with ergotamines, MAOIs or other 5HT1 agonists
62
Q

What could be given to people with insomnia as well as migraines?

A
  • Sedative/hypnotic like diazepam

- Major tranquilizer like thorazine

63
Q

What should be done if someone has multiple headaches per week?

A
  • Consider preventative meds
64
Q

What are some preventative measures for headaches?

A
  • Antidepressants –> TCAs, SSRIs, SNRIs, MAOIs
  • B-blockers
  • CCBs
  • Anticonvulsants
  • Ergot alkaloids
  • NSAIDs
  • Muscle relaxants
  • Methysergide
  • BOTOX injection has been shown to treat chronic migraine
65
Q

What are some nonprescription treatment options of migraine?

A
  • Exercise
  • Stop smoking
  • HA education
  • Riboflavin
  • Magnesium
  • Stress management
66
Q

What is used for the acute treatment of tension headaches?

A
  • OTC analgesics
  • NSAIDs
  • Opioids
  • Midrin
67
Q

What is the treatment for cluster headaches?

A
  • DHE 1 mg IM or ergotamine 2mg SL
  • Lidocaine 4%
  • Narcotics
  • Oxygen 100% 8L/min by mask
  • Sumatriptan 6mg SQ
  • Zolmitriptan nasal spray
68
Q

What can be used for preventative treatment for cluster headaches?

A
  • CCBs
  • Anticonvulsant
  • Lithium
  • Indomethacin
  • Prednisone
  • Ergotamine tartrate
69
Q

What is trigeminal neuralgia?

A
  • Excruciating sharp, shooting, electrical quality pain occurring in paroxysm
70
Q

What is the treatment for trigeminal neuralgia?

A
  • Carbamazepine

- Oxcarbazepine

NMSP Exam 1 (12 decks)

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