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Neuro > Headache > Flashcards

Headache Flashcards

0
Q

migraine

A

syndrome characterized by intermittent pounding or throbbing headache, potentially preceded by an aura

frequent association with nausea, photophobia, phonophobia and exertional worsening

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1
Q

subarachnoid hemmorhage

A

bleeding into the CSF fluid, usually due to leakage of an aneurysm or vascular malformation

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2
Q

tension-type headache

A

recurrent headache with a bilateral squeezing and pressing senation that usually does not prevent normal activity and does not significantly worsen with exertion

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3
Q

cluster headache

A

recurrent, severe headache which is unilateral and periorbital and often asociated with autonomic symptoms of tearing and nasal congestion

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4
Q

temporal arteritis

A

condition of inflammation of major cranial blood vessels–>can result in blindness or stroke depending onvessels involved

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5
Q

paresthesia

A

abnormal sensation that is not due to an external stimulus

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6
Q

aura

A

warning, prior to onset of a symptom

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7
Q

increased intracranial pressures do NOT

A

cause headaches

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8
Q

drainage of spinal hluid

A

causes low pressure headache secondary to fluid traction on venous sinuses when brain sinks towards tentorium as it loses CSF

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9
Q

inflammation in subarachnoid space

A

results in headache

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10
Q

lesions above tentorium produce

A

pain referred to trigem distributions (forehead, behind eyes) because dura in this region is supplied by trigem nerve

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11
Q

lesions in posterior fossa produce

A

pain ine ar, back of head (cn 9,10, and upper 3 cervical roots)

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12
Q

meningeal irritation headache

A

subarachnoid hemorrhage and meningitis

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13
Q

subarachnoid hemorrhage

A

sevre, sudden onset, persists, remainder of neuro exam normal

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14
Q

what do you do if you suspect subarachnoid hemorrhage?

A

do CT

if CT negative, do lumbar uncture

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15
Q

neoplasms

A

mild, nonspecific, worse in morning

focal symptoms

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16
Q

abscess

A

focal signs of mental changes often present
evidence of increased ICP
infection?

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17
Q

acute hydrocephalus

A

caused by obstructing CSF pathways (inflammation, blood, tumor)
brain dysfunction
fundi–>increased ICP

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18
Q

predisposing factors to intracranial hypertension

A

polycystic ovarian disease
high estrogen
exogengeous estrogen, vitamin a, outdated tetracycline

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19
Q

what helps intracranial hypertension

A

carbonic anhydrase inhibitors

shunting

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20
Q

protoypical patient for intracranial hypertension

A

overweight young woman

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21
Q

three types of vascular headaches

A

giant cell (temporal) arteritis
hypertensive encephalopathy
vascular malformation

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22
Q

giant cell temporal arteritis

A

systemic vasculitis
hypertensive encephalopathy
vascular malformation

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23
Q

giant cell temporal arteritis

A

systemic vasculitis that likes cranial nerves; usually in people over 50

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24
Q

clinical picture giant cell arteritis

A

1- polymyalgia rheumatic- malaise, loss of energy, proximal jt pains
2- nonspecific headaches; associated with tenderness and swelling over temporal or occipital arteries
3- evidence of arterial insufficiency in distribution of branches of cranial vessels (jaw cluadication, infarction of tongue or scalp)

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25
Q

external carotid insuffiency

A

jaw claudication or infarction of the tongue or scalp

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26
Q

internal carotid insuffiency

A

produces retina ischemia, blindness, even stroke

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27
Q

sed rate giant cell arteritis

A

very high

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28
Q

treatment giant cell arteritis

A

steroids

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29
Q

ddx lupus

A

lupus inflames systemic

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30
Q

to confirm after high sed rate

A

biopsy (bilaterally)

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31
Q

hypertensive encephalopathy

A

cerebral vasoconstriction occurs in response to systemic HTN to preserve a constant cerebral blood flow–>autoregulation
–in this, autoreg fails at parts and arteries dilate despite severe HTN (–>edema and hemorrhage)

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32
Q

hypertensive encephalopathy should be considered

A

patients with severe HTN, or preveiously normotensive patients that develop less evere HTN

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33
Q

vascular malformations

A

may result in headaches with features of migraine

34
Q

venous sinus thrombosis

A

headache probably results from stretching of pain sensitive veins that drain into sinuses (although increased ICP may play a role)

35
Q

main predisposing factors of venous sinus thrombosis

A

hypercoagulability and increased osmolarity

high estrogen states, dehydration

36
Q

cervical headache

A

pain from cervical region–usually felt over neck and occiput–>can be refferred around temples and even into frontal region

37
Q

two types of cervical headaches

A

occipital neuralgia-irritation or entrapment of grater occipital nerve
aterial dissection-result in acute neck pain sometimes acompanied by ischemic symptoms-

38
Q

metabolic headaches

A

often associated with hypoxemia, hypercapnia, anemia and possibly associated with cerebral vasodilation

39
Q

glaucoma

A

pain localized in the eye or behind the head

40
Q

most significant criteria of dangerous headache

A

duration

41
Q

migraine aura assocaited wtih

A

intracranial vasoconstriction

42
Q

BV dilation

A

does not directly cause pain; pain does appear to be from activation of nerves in BV that contribute to sterile inflame dilation

43
Q

spreading depression

A

most prominant theroy of causation: slowly spreading wave of initial neuronal excitation, followed by depression that spreads over cortex

44
Q

scintillating scotomata

A

enlarging blind spot with shimering edge

45
Q

negative scotomata

A

blurring of visual field

46
Q

photophasia

A

colored blind spots

47
Q

fortification spectra

A

jagged lines

48
Q

symptoms in migraine often____, but can also be____

A

homonymous (cortical involvment)

visual loss in one eye due to retinal ischemia

49
Q

somatosensory march of migraine can be diffferentiated from sensory seizures by

A
  • gradual onset
  • slow march (several minutes between)
  • NOT restricted to single BV as they are progressing on somatotrophic area
  • usually clears first in area that was first involved
50
Q

general progression of aphasia in aura

A

visual

  • ->sensory
  • ->speech
51
Q

occulomotor, abducents nerve involvment in aura

A

less often, but may last for several weeks after onste at height of headache
mech–dilation of ICA compressed 3rd or 6th nerve in cavernosus sinus to cause paresis or paralysis

52
Q

familial hemiplegic migraines

A

onset early in childhod, strong family history common (genetics)

53
Q

Type 1 FHM

A

CACNA1A gene (P/Q channel)

54
Q

Type 2

A

Na-K ATPase

55
Q

Type 3

A

involves neuronal voltage gated Na channels

56
Q

in FHM..

A

headache appears first and symptoms of weakness and sensory loss appear later
–neuro signs freq outlast headache by hours or days and occasionally may be permanent

57
Q

treatment of migraine

A

avoidance of trigger factors
medications during headache
preventative (prophylactic) medications

58
Q

medications DURING headache

A
  • nonspecific analgesics/anti-inflam

- meds that activate 5HT R (ergotamine derivatives and triptans)

59
Q

mechanism of ergotamine derivs and triptans

A

capable of affecting trigem nerve endings on BV–>decrease release of inflame neuropeptides (CGRP, Sub P) and constrict BV

60
Q

two primary difficulties with short acting analgesics

A

becomes less effective when migraine is well established

frequent use of short acting meds results in gradual decrese in response to these meds (rebound headache)

61
Q

preventative mds

A

betablockers
ca channel blockers
heterocyclic antidepressants
anticonvulsants

62
Q

pacing the floor

A

cluster headache

63
Q

horners syndrome

A

cluster headaches

64
Q

gender and cluster headache

A

men more than women

65
Q

migrane chemicals

A

increase in level of blood 5HT at the onset of headaches and later a depletion

66
Q

cluster headaches (differentially)

A

no change in 5HT levels, but have an increase in blood histamine concentration coincident with headache

overactivity in caudal hypothalamus during attack
breathing in O2 aborts quickly
no aura

67
Q

tension type headache

A

when under pressure, mild cervical or bifrontal headache

hyperactivity of frontalis and cervical musculature

68
Q

tension type headaches are more likely to be

A

chronic, and threfore more likely to result in frequent analgesic intake
analgesic rebound headache may be a problem

69
Q

indomethacin responsive headache symptoms

A

group of headache symptoms that share characteristics of being highly responsive to indomethacin (as opposed to other NSAIDs)

70
Q

IRHs fall into several categories

A

trigeminal-autonomic cephalgias (unilateral headache accompanied by a variety of autonomic symptoms in head)
headaches induced by valsalva
headaches taht have primary stabbing quality

71
Q

trigeminal autonomic cephalgias

A 
Short lasting
Unilateral
Neuralgiform headache
Conjunctival injfection
Tearing

-middle aged men; reocur but only last a few minutes

72
Q

trigem autonomic cephalgias vs paroxysmal hemicranias

A

similar but pain is longer and genreally in women

73
Q

indomethacin responsive headache symptoms

A

sharp and localized, short duration

74
Q

neuralgias

A

sharp, severe, brief
“trigger point”-areas of skin or mucosa that prvoke pain when touched
no sensory nerve included

75
Q

Tic douloreaux

A

trigeminal neuralgia; usually occurs in elderly and involves second and tird trigem division
no sensory loss
treatment with carbamezapine- if dont treat you will need a procedure

76
Q

glossopharyngeal neuralgia

A

less common; pain felt in throat, ear, neck

may be triggered by swallowing

77
Q

definitive test for identifying aneurysm

A

angiogram

78
Q

only way to rule out subarachnoid hemorrhage

A

lumbar puncture

79
Q

sudden onset headache with focal neurologic deficit

A

intracerebral hemorrhage

80
Q

treatment of giant temporal arteritis can prevent

A

blindness

stroke

81
Q

headache that awakens from sound sleep

A

increased intracranial pressure?

mass lesion, sagittal sinus thrombosis, pseudotumor cerebri

82
Q

behavior or personality change

A

encephalitis, mass

83
Q

migraine unilateral or bilateral

A

unilateral

Neuro (23 decks)

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