tx Bell’s Palsy? (3)
Prednisone 60 mg taper x 10 days
Valacyclovir 1 g TID x 7 days
artificial tears/eye lubei
indications for labs/imaging in Bell’s Palsy (2)
fasting blood sugar in DM
MRI if bilateral or no forehead involvement
nerve branches more commonly affected by trigeminal neuralgia?
V2 and V3
Bell’s palsy is more common on which side
right
tx trigeminal neuralgia (4)
Carbemazepine starting 100-200 BID —> 600-1200 mg/day
Anticonvulsants: Lamotrigine, gabapentin, phenytoin
peripheral nerve block
surgical intervention for refractory pain
carbamazepine tx special characteristic?
regular CBCs
jaw claudication
temporal arteritis
diagnostic criteria for temporal arteritis
3/5: age at onset > 50 new localized HA temporal a. tenderness and decr. temporal pulse ESR> 55 positive temporal a. biopsy
classic lab finding of temporal arteritis
elevated ESR
biopsy for temporal arteritis? (2)
multinucleate giant cells
need > 2 cm of artery due to skip lesions
tx temporal arteritis (2)
Prednisone
monitor ESR
unilateral weakness/paralysis, numbness, eye irritation, onset w/in 3 days
involves the forehead
Bell’s Palsy
periauricular pain & tenderness, crepitus w/ jaw mvmt
TMJ dysfunction
more frequent form of migraine?
migraine w/o aura (“common”)
throbbing, pulsatile unilateral pain. 4-72h
N/V, confusion, blurred vision, mood changes, sensitivity to light & sound
migraine w/o aura
visual, verbal, or sensory sx 10-60 min prior to HA
usually unilateral. N/V, photophobia, etc
migraine w/ aura
“classic”
indications for imaging w/ HA (5)
changes in HA new neuro sx refractory new onset after 50 HIV or CA pts
chest pressure/heaviness, flushing, weakness, drowsiness, dizziness, malaise, warmth, paresthesias
triptan sensation- a side effect
triptan contraindications (5)
uncontrolled HTN hx MI CVD PVD pregnancy
preventative migraine mgmt prescriptions (3)
B-blockers: Propranolol
antidepressants: TCAs, SSRIs
anticonvulsants: Topiramate
most common type of HA?
tension type
infrequent tension type HA classification?
frequent tension HA classification
10-14 days/mo
lasting 30 min to several days
chronic tension HA classification
> 15 days/mo
lasts hours to days
tension HA triggers (5)
stress/lack of sleep jaw clenching missed meals depression head/neck strain
sharp, boring, unilateral, periorbital HA w/ autonomic sx
attacks last 15-180 min
cluster HAs
cluster HA disease course (4 types)
attacks: every other day, 8x day
clusters: 6-12 weeks
remission: up to 12+ months
chronic: clusters lasting > 1 years or remission
restless pt, sitting, rocking. Conjunctival injection, lacrimation, eyelid edema, nasal congestion, ptosis, miosis, sweating
cluster HA
triggers for cluster HA
alcohol
smoking
stress
cluster HA imaging indication
always initially- these things are crazy!
MRI or CT
cluster HA tx (3)
O2, nonrebreather for 15 min
subQ sumatriptan
Verapamil as preventative
moderate pain on sides or top of head
> 15 days/mo during 3+ months
chronic daily HA
continuous, fluctuating pain or same side of face/head lasting minutes to days
may have tearing, irritated eyes, rhinorrhea
hemicrania continua
tx hemicrana continua (2)
indomethacin
&/or corticosteroids
mild-severe pain, throbbing/tightening bilaterally. light/sound sensitivity
may be following infection, meds, trauma, other condition
newly daily persistent HA
tx newly daily persistent HA (3)
muscle relaxants
antidepressants
anticonvulsants
primary stabbing HA tx (3)
indomethacin
abortive drugs
trigger avoidance
primary exertional HA workup
MRI/MRA to r/o vascular abn
> 50 y/o, develops during sleep and wakes people up
mild-moderate throbbing, both sides of the head
hypnic HA
hypnic HA disease course
> 10 episodes/month
lasting 15 min- 3 h
hypnic HA workup & treatments (3)
MRI: new presentation over age 50, waking up at night
caffeine at night
indomethacin
lithium
indications for CT/MRI, ~ LP (5) with secondary HA
Systemic symptoms or illness (HIV, CA, infection, sinusitis) Neurological hx Onset sudden Older (> 50 y/o) Previous hx (1st HA or change)
sx increase w/ cough, exertion, straining, position change
Papilledema, vision loss, pulsatile tinnitus
idiopathic intracranial HTN
unilateral HA that’s not a migraine, secondary can be
CVA
delayed onset of dizziness, tinnitus, N/V, visual changes
hx trauma
post concussion syndrome
