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ADAMS > Headache and other Craniofacial Pains > Flashcards

Headache and other Craniofacial Pains Flashcards

1
Q

cranial structures sensitive to noxious stimuli

A
  1. skin, subcutaneous tissues, muscles, extracranial arteries, external periosteum of the skull
  2. delicate structures of the eye, ear, nasal cavities, paranasal sinuses
  3. intracranial venous sinuses, large tributaries
  4. parts of the dura at the base of the brain an dthe arteries within the dura,
  5. middle meningeal and superficial temporal arteries
  6. first three cervical nerves and cranial nerves as they pass through the dura
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2
Q

Projection of pain from the ffg structures

  1. middle meningeal artery
  2. intracranial segment of ICA and proximal parts of ACA, MCA
  3. pain from infratentorial structures
  4. neck
  5. 7th, 9th and 10th CN
A
  1. back of the eye and temporal area
  2. eye and orbitotemporal regions
  3. vertex ad back of the head
  4. second cervical roots
  5. nasoorbital region, ear, throat
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3
Q

Mechanisms by which nitroglycerin, nitrates, monosodium glutamate causes headache

A

dilatataion of intracranial and extracranial arteries

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4
Q

Migraine

A

highly prevalent and largely familial disorder characterized by periodic, commonly unilateral, often pulsatile headaches that begin in childhood, adolescence, or early adult life and recur with diminishing frequency during advancing years

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5
Q

Aka Migraine with aura

A

Classic Migraine

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6
Q

Aka migraine without aura

A

Common Migraine

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7
Q

T/F

In migraine, movement of head intensifies severity of headache

A

true

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8
Q

Most characteristic features of Migraine

A

hemicranial

throbbing (pulsating)

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9
Q

ratio of classic (with aura) to common (without aura)

A

1:5

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10
Q

how many percent of patients have migraine with onset before 30 yrs of age

A

80%

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11
Q

in migraineurs, the attacks are exclusively perimenstrual in how many percent

A

15%

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12
Q

mechanism in menstrual migraine

A

withdrawal of estradiol

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13
Q

T/F

Migraine tends to cease during the second and third trimesters of pregnancy in 75-80% of women.

A

True

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14
Q

T/F
The use of birth control pills is associated with an increased frequency and severity of migraine and in rare instances has resulted in permanent neurologic deficit

A

True

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15
Q

food content which has been incriminated as a provocative factor in migraine

A

tyramine

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16
Q

triggers if migraine

A

alcohol (red wine or port)
exposure to glare or strong sensory stimuli
sudden jarring of head
rapid changes in barometric pressure

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17
Q

T/F

The incidence of seizures is slightly higher in migrainous patients and their relatives than in the general population.

A

True

there are syndromes that encompass both disorders

18
Q

mechanisms implicated in the pathogenesis of arterial occlusion and strokes that complicate migraine

A 
platelet aggregation
edema of the arterial wall
increased coagulability
dehydration from vomiting
intense, prolonged spasms of vessels
19
Q

T/F

Migraine may be a prominent feature in MELAS and CADASIL

A

True

20
Q

Sumatriptan acts selectively on which receptors

A

5-HT1B/D

21
Q

Side effect of ergotamine

A

peripheral and coronary vasoconstrictor

headache

22
Q

how to give ergotamine

A

1-2 mg tab held under the tongue until dissolved or i combination with caffeine

23
Q

ergots and triptans are contraindicated in

A

symptomatic and asymptomatic CAD and poorly controlled hypertension

because of cerebral vasospasm

24
Q

how to give propranolol as prophylaxis in migraine

A

10-20 mg x daily and increasing the dose gradually to as much as 240mg/daily

25
Q

If propranolol is unsuccessful as prophylaxis, what next

A

may give other beta blockers, lacking agonist properties
atenolol 40-160mg/d
timolol 20-40mg/day
metoprolol 100-200mg/d

if patients are unresponsive after 4-6 weeksm may give Valrpoic Acid 250 3x-4x daily
topiramate or amitryptyline 25-125 mg nightly may be tried

26
Q

side effect of methysergide i

A

retroperitoneal and pulmonary fibrosis

27
Q

indomethacin-responsive headaches

A 
orgasmic migraine
chronic paroxysmal hemicrania
hemicrania continua
exertional headache
hypnic headache
brief head pains
28
Q

occurs predominantly in men
severe consistent unilateral orbital localization
nightly recurrence between 1 and 2 hr after the onset of sleep or several times during the night

A

cluster headache

29
Q

treatment of cluster headchae

A

100% oxygen via face mask for 10-15 mins at the onset of cluster headache may abort the attack

30
Q

Other meds for cluster headache

A

verapamil 80mg QID

ergotamine 2mg at night
intranasal lidocaine or sumatriptan may be useful to abort an attack

31
Q

T/F

The incidence of tension headache is certainly greater than that of migraine

A

True

32
Q

T/F

Like migraine, tension headaches are more common in women than in men

A

True

33
Q

T/F

Unlike migraine, tension headaches infrequently begin in childhood or adolescence but are more likely to arise in middle age.

A

True

34
Q 
inflammatory disease of cranial arteries
patients are older than 55
increasingly intense throbbing or nonthrobbing headache with superimposed sharp/stabbing pains
sometimes explosive 
localized to affected arteries on scalp
A

Headaches of Temporal Arteritis

35
Q

Importance of early diagnosis of Temporal Arteritis

A

threat of blindness from thrombosis of the ophthlamic or posterior ciliary arteries

36
Q

T/F

Large intracranial vessels are occasionally affected in Temporal arteritis, thereby causing stroke

A

True

37
Q

T/F

In temporal arteritis, once vision is lost, it is seldom recoverable.

A

True

38
Q

Biopsy result of scalp artery in Temporal arteritis

A

intense granulomatous, or giant cell arteritis

39
Q

Treatment for Temporal Arteritis

A

prednisone 45 to 60mg/day in single or divided doses over a period of several weeks

with gradual reduction to 10-20mg/day and maintenance at this dosage for several months or years

Headache can be expected to improve within a day or two of beginning treatment, failure to do so brings the diagnosis into question

40
Q

treatment for trigeminal neuralgia

A 
Carbamazepine is effective in 70-80% of patients
600-1200mg/d
phenytoin 300-400mg/d
Valproic Acid 800-1200 mg/d
clonazepam 2-6mg/d
gabapentin 300-900mg/d
pregabalin 150-300mg/d

ADAMS (29 decks)

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