9: Headache Flashcards Preview

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Flashcards in 9: Headache Deck (34):
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Primary headache

Migraine
Tension-type headache
Cluster headache
Paroxysmal hemicrania
Primary cough headache
Primary headache associated with sexual activity
Hemicrania continua

1

Status migrainosus

A debilitating migraine attack lasting for more than 72 hrs

2

Chronic migraine

Migraine headache occurring on 15 or more days per month for more than 3 months

3

Persistent aura without infarction

aura sx persist for more than 1 week without radiographic evidence of infarction

4

Migraine triggered seizure

One type of epileptic attack occurs during or within 1hr after a migraine aura

5

Childhood periodic syndrome

1: cyclic vomiting
2: abdominal migraine
3: Benign paroxysmal vertigo of childhood

6

Abdominal migraine

an idiopathic recurrent disorder seen mainly in children and characterized by episodic midline abdominal pain manifesting in attacks lasting 1-72hrs with normally btw episodes. At least 5 attacks should have occurs

7

Cyclic vomiting

recurrent episodic attacks of vomiting and intense nausea lasting from 1hr to 5days. Attacks are associated with pallor and lethargy. There is complete resolution of sx btw attacks. At least 5 attacks

8

Migraine without aura- dx

-at least 5 attacks
-headache lasting 4-72hrs
-at least 2 of following (characteristic of headache)
--unilateral location
--pulsating quality
--moderate or severe pain intensity
--aggravation by or causing avoidance of routine physical activity
-during headache at least 1
--nausea and/or vomiting
--photophobia and phonophobia

9

Migraine with aura

Aura- lasting 5-60mins
-fully reversible..
visual sx
sensory sx
dysphasic speech disturbance

10

Familial hemiplegic migraine (FMH)

presents with transient hemiplegia during aura
-Ophthalmoplegia- double vision
-Strabismus- paralysis of EOMs

11

Basilar migraine**

Visual field disturbances, cerebbellar signs (ataxia, dysarthria)
Cranial nerve involvement (vertigo)
Sensory and motor involvement

12

Bickerstaff's migraine

basilar migraine in adolescent females
-Total blindness*, accompanied by admixture of vertigo, ataxia, dysarthria, tinnitus, perioral paresthesia, and occasional confusional state

13

Migraine -non-pharmacological tx

identify and remove triggering factors
-alcohol
-food
-hunger
-irregular sleep patterns
-organic odors
-sustained exertion
-glare, flashing light
-acute stress
avoid environmental factors
-time zone shift, weather changes, pressure changes
Menstrual cycle

14

Migraine- pharm tx- acute

NSAIDS
Triptans* (DOC, selective 5HT1 agonist, contraindicated in pts with CVD*)
Ergotamine, dihydroergotamine (non selective 5HT1)
Metoclopromide, prochlorperazine (DA antagonists)
Narcotic analgesics

15

Migraine- prophylactic tx

Indication: 3 or more attacks a month
-beta blocker: propranolol*
-Ca channel blocker: Flunarizine*
-5HT agonist: methysergide, cyproheptadine
-anticonvulsants: sodium valproate

16

Tension type headache

Headache- bilateral, tight, band like pain (not throbbing)
No nausea or vomiting
No prodrome
Not aggravated by physical activity
Frontal-occipital location

17

Tension type headache- tx

Relaxation
NSAIDS
Prophylactic: TCA anti-depressants (Aitriptyline, Doxepin, Nortriptyline)

18

Cluster headache-info

Sudden periorbital or temporal pain
unilateral
Reaches crescendo within 5mins
Lasts 30mins-2hr
associated with
-homolateral lacrimation
-reddening of eye and nasal congestion
-ptosis
-nausea
Alcohol provokes (70%)
Nocturnal (50%; awakens pt within 2hrs of falling asleep)
Periodic (occur at the same hour everyday)

19

Cluster headache- tx

100% oxygen mask for 15min** (abortive)
Sumatriptan
Prednisone
Lithium
Ergotamine

20

Chronic paroxysmal hemicrania

brief, severe unilateral orbital, supraorbital or temporal throbbing pain
Lasts 2-45mins*
At least 50 attacks a day
Pain with at least one of following
-1: conjunctival injection, 2: lacrimation, 3: nasal congestion, 4: rhinorrhea, 5: ptosis, 6: eyelid edema

21

Chronic paroxysmal hemicrania- tx

Indomethacin (150mg daily or less): absolutely effective***

22

Cough headache

headache on coughing, bending, sneezing, lifting
MRI is usually indicated to rule out structural anomalies/ brain tumor
-Chiari malformation

23

sx associated with SERIOUS underlying cause of headache

- worst headache ever
-first severe headache
-'Thunderclap' headache
-Subacute worsening over days or weeks
-Abnormal neurological exam
-Fever or unexplained systemic signs
-Vomiting precedes headache
-Induced by bending, lifting, coughing
-Disturbs sleep or present immediately upon wakening
-Known systemic illness
-Onset age after 55yrs

24

Headache- brain tumor/ space occupying lesion (SOL)

may worsen with exertion and change in position
pain appear with bending, lifting, coughing-> posterior fossa tumor
early morning headache that improves with day*
Unilateral papilledema

25

Temporal arteritis

Headache- worse at night and on exposure to cold
Tenderness and redness over temporal arteries
Loss of vision or impaired vision
Polymyalgia rheumatica*
Jaw claudication* (pain with chewing)
Bx: dx
Tx: prednisone 4-6 weeks

26

Acute glaucoma

IOP>21mmHg
Pathological cupping of optic disc
Loss of field of vision

27

Acute glaucoma- tx

-Block aqueous production: Timolol*, Acetazolamide*
-Reduced vitreous volume: oral glycerol, mannitol
-Facilitate aqueous outflow: pilocarpine*
-surgical: Iridotomy

28

Acute sinusitis

Pain or tenderness over sinuses
dx- CT shows mucosal thickening
tx- decongestants (Pseudoephedrine)

29

Idiopathic intracranial hypertension (IIH)(Pseudotumor cerebri)

Increased ICP without any evidence of brain path
associated with VitaminA, Nalidixic acid, Danazol, Steroid withdrawal
Tx: Acetazolamide, Corticosteroids, Furosemide, CSF shunt (Ventriculoperitoneal shunt)

30

Analgesic rebound headache- tx

Stop analgesics
Hydroxyzine*

31

Trigeminal neuralgia- tx

Carbamazapine*
Radiofrequency ablation of a portion of the trigeminal ganglion
Anesthetic blocks

32

Headache after Lumber Puncture

Increases on sitting and standing and decreases on reclining and on increasing abdominal pressure

33

Headache after Lumbar Puncture- tx

if pain persists
-Caffeine sodium benzoate**
-Epidural blood patch (if CSB fails)