3-4-2015 Headache & Brain Tumors

Question 1

Cluster Headache

Answer 1

• Frequency: 0.5-8/day
• Description: Severe, Unilateral orbital/supraorbital/temporal, 15 minutes to 3 hours
• Includes at least 1 associated symptom (parasympathetic symptoms)

Question 2

Migraine Headache

Answer 2

• 4-72 hours duration
• Description: Unilateral, pulsatile, moderate, worse with activity
• S/S: n/v, photo/phonophobia
• F>M
• Predictive symptoms: nausea, photophobia, disability

Question 3

Tension-Type Headache

Answer 3

• 15 or more days per month
• Bilateral tightening, mild/moderate, not worse with activity
• Minimal n/v/photo/phonophobia

Question 4

Sumatriptan

Answer 4

o 5-HT(1B/D) receptor agonist on cerebral blood vessels
o Inhibit release of vasoactive peptides (CGRP)
o Promote vasoconstriction
o Block brainstem pain pathways
o Inhibit trigeminal nucleus caudalis
o Treatment of migraine headaches….stops existing ones
o Oral/nasal/SubQ, sometimes in combination with naproxen
o Frovatriptan & Naratriptan have longer half-lives

Question 5

NSAIDSs, DHE/ergots, Steroids, Butalbital, Caffeine

Answer 5

Abortive Headache medications (along with the triptans)

Question 6

Amitryptyline, Nortriptyline

Answer 6

TCAs - headache prophylaxis

o Sedating, anticholinergic, effective for many pain sources

Question 7

Valproic Acid, Topiramate

Answer 7

Antiseizure - headache prophylaxis

o Others – gabapentin, pregabalin, lamotrigine

Question 8

B-blockers, CCBs

Answer 8

BP Meds - Headache prophylaxis

• B-blockers = Propranolol, Atenolol
• CCBs = Verapamil, Diltiazem

Question 9

Astrocytoma

Answer 9

• Most common glial tumor
• S/S: depends on location/size, gradual onset
• Grade 1 = pilocytic astrocytoma
  o Kids, cerebellum, mural nodule, Rosenthal fibers
  o Will not progress
  o Well demarcated, often cystic contrast-enhancing tumor
• Grade 2 = diffuse astrocytoma
  o Nuclear atypia
• Grade 3 = anaplastic astrocytoms
  o Mitotic activity
• Grade 4 = glioblastoma multiforme
  o Necrosis, vascular proliferation, pseudopallisading

Question 10

Oligodendroglioma

Answer 10

• Adults in 5th to 6th decade
• S/S: history of progressive neuro symptoms
• Imaging: well-defined hypodense/hypointense mass, may see calcification
• Histo: Fried egg cells, calcifications
• Grade 2 = oligodendroglioma
• Grade 3 = anaplastic oligodendroglioma
  o Loss of chromosome 1p and 19q = better survival prognosis (susceptibility to chemotherapy)