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Clin Med IV Exam II > Headaches > Flashcards

Headaches Flashcards

1
Q

Three primary headache syndromes

A
  • migraine
  • tension type headache
  • cluster headache
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2
Q

What should you ask a patient c/o a headache

A
  • quality
  • intensity
  • location
  • mode of onset
  • relationship to biologic events
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3
Q

Most important characteristic of “quality” of a headache

A

if it is pulsatile or not

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4
Q

Quality of a migrain

A

pulsating, throbbing, lateral

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5
Q

Quality of a tension headache

A

tightness and pressure, band like

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6
Q

Quality of neuritis

A

sharp, lancinating

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7
Q

Quality of cluster headache

A

ice pick

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8
Q

Quality of a headache d/t an intercranial lesion

A

dull or steady

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9
Q

Quality of a headache from opthalmologic disorder

A

peri-ocular pain

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10
Q

Quality of neuralgia

A

localized to a division of the trigeminal nerve

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11
Q

Headaches that wake a pt up from sleep

A

HA from meningitis, subarachniod, cluster HA

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12
Q

Where do migraines occur

A

on one side

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13
Q

HA d/t inflammation of an extracranial artery causes pain where

A

localized to the site of the vessel

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14
Q

Lesions of the paranasal sinuses, teeth, eyes, and upper CV cause pain where

A

across the forehead or maxilla or around the eyes

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15
Q

Intracranial lesions in the posterior fossa cause pain where

A

occipitonuchal region

unilateral if lesion is one sided

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16
Q

HA worse with wakening–>

A

sleep apnea or intracranial mass

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17
Q

HA at same time each day–>

A

cluster HA

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18
Q

What types of HA are worse at the end of the day

A

tension HA

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19
Q

HA that have an onset of seconds to minutes

A
  • subarachnoid

- thunderclap HA

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20
Q

HA that have an onset of minutes to hours

A
  • migraines
  • cluster
  • intracranial tumor
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21
Q

HA that have an onset of hours to days

A
  • migraines

- tension HA

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22
Q

Catamenial migraine

A

HA that occurs regularly in the premenstrual period

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23
Q

HA worse with sudden movement or by coughing or straining think—> ?

A

intracranial source

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24
Q

Allodynia

A

pain when the scalp is stroked in combing or fixing the hair

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25
Q

What is a tension headache

A

tension or spasm withing the pain sensitive muscles of the neck or temples

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26
Q

What is not associated with a tension HA

A
  • photophobia
  • phonophobia
  • nausea
  • vomiting
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27
Q

Tension HA gets worse with what

A

stress, noise, glare

28
Q

What should be check in a pt over 60 presenting with a tension type headache

A

ESR look for Giant cell arteritis

29
Q

What is not indicated for tension HA tx

A

Triptans

30
Q

Treatment for tension HA

A
  • similar to migraines
  • treat co-morbid anxiety and depression
  • behavioral therapy, relaxation training
  • massage
31
Q

Migraine HA

A

episodic severe HA pain associated with nausea, photophobia and photophobia

32
Q

Migraine HA may be associated with what

A

meningeal signs

33
Q

PT’s can experience what before a migraine

A

aura

34
Q

Most important question to ask your pt if considering migraine

A

have you ever had a headache like this before?

35
Q

People with migraines experience what types of things

A

positive phenomena

Complex migraines–> speech or motor deficits

36
Q

Criteria for migraine without aura

A

At least 5 attacks fulfilling following criteria:

  • last 4 to 72 hours
  • 2 of the following characteristics: unilateral, pulsating, moderate to severe intensity, aggravation by physical activity
    - at least one of the following: N/V, photophobia and phonophobia
    - no evidence of an underlying condition
37
Q

Criteria for migraine with aura

A

At least two of attacks fulfilling the following

- three of the following: one or more reversible aura sx, at least one aura sx developing gradually, no aura lasting longer than 60 minutes, HA following aura w/ a free interval of less than 60 minutes
- no evidence of underlying disorder
38
Q

What occurs with a basilar artery migraine

A

blindness or vision changes followed by paresthesias, disequilibrium, confusion states and occipital migraine

39
Q

Opthalmoplegic migraine

A

lateralized pain in the eye accompanied by N/V, diplopia

40
Q

Tx of migraines

A
  • avoid precipitating factors
  • prophylactic
  • symptomatic pharmacologic treatment
41
Q

Tx during acute migraine attack

A
  • rest in a dark quiet room
  • simple analgesic
  • ergotamines
  • compazine
  • reglan
  • butalbital containing analgesics
42
Q

When should ergotamines be avoided

A
  • pregnancy
  • CV disease
  • CYP3A4 inhibitors
43
Q

Triptans are often given with what

A

naproxem

44
Q

Triptans should be avoided in what

A
  • pregnancy
  • hemiplegic or basilar artery migraine
  • uncontrolled HTN
  • RF for stroke
  • coronary or peripheral vascular disease
45
Q

Triptans can cause what

A

nausea and vomiting

46
Q

When is preventative therapy for migraines indicated

A

if migraines occur >2-3 times a month

47
Q

Preventative migraine rx

A
  • botulism toxin type A injected into muscles
  • triptans
  • acupuncture
  • neurostimulation techniques
48
Q

Pain in a cluster HA

A
  • deep
  • retroorbital
  • nonfluctuating
  • explosive in quality
49
Q

Core feature of cluster HA

A

periodicity

50
Q

Associated features of cluster HA

A

tearing, miosis, ptosis, rhinorrhea

51
Q

Prophylactic agents for cluster HA

A
  • lithium carbonate
  • verapamil
  • topiramate
52
Q

Treated of acute cluster HA

A

Often ineffective

  • SC or intranasal triptans
  • high flow O2
  • dihydroergotamine IM or IV
  • viscous lidocaine IN
53
Q

Post traumatic headache

A

1 day to week after injury

54
Q

Characteristic of post traumatic HA

A

dull ache, may be accompanied by N/V, scintillating scotomas

55
Q

What casues HA with intracranial mass lesions

A

displacement of vascular structures and pain sensitive tissues

56
Q

When should you urgently refer a pt with a HA

A
  • thunderclap onset
  • increasing HA unresponsive to simple measures
  • hx of trauma, HTN, fever, visual changes
  • presence of neurologic signs and scalp tenderness
57
Q

Pseudotumor cerebri

A

idiopathic intracranial HTN characterized by papilledema, increased ICP with normal CSF, normal or small sized ventricles seen on brain imagine

58
Q

Pseudotumor cerebri affects who

A

obese women, peaks in 3rd decade

59
Q

When is the diagnosis of pseudotumor cerebri made

A
  • pt has sx of increased ICP
  • no localizing sx
  • nonspecific or normal imaging study
  • CSF pressures are elevated over 250 w/ otherwise normal findings
60
Q

Treatment of pseudotumor cerebri

A
  • repetitive LP
  • carbonic anhydrate inhibitors
  • thiazides
  • corticosteriod if visual complaints
61
Q

Surgical tx for pseudotumor cerebri

A
  • lumbar peritoneal shunting

- optic nerve sheath decompression

62
Q

Post herpetic neuralgia has a high occurance in what population

A
  • elderly
  • immunocompromised
  • pts with severe rash
  • when first division of trigeminal is affected
63
Q

Postherpetic neuraliga is characterized by

A

constant, severe, stabbing or burning, dysesthetic pain

64
Q

Most common affected nerve with postherpetic neuralgia

A

V1

65
Q

Testing of the painful area with postherpetic neuralgia will show what

A

decreased cutaneous sensitivity to pinprick

66
Q

Tx of post herpetic neuralgia

A
  • anticonvulsants
  • gabapentin
  • antispasmodic agents
  • botox
  • surgery
  • brain stereotactic radiosurgery
  • glycerol injection
  • balloon compression
67
Q

Major complication of herpes zoster in the trigeminal distribution

A

impaired blink reflex–> corneal abrasion, scarring and vision loss

Clin Med IV Exam II (8 decks)

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