Carlson: Headache Flashcards
(14 cards)
Most common causes of secondary headache
subarachnoid hemorrhage meningitis abnormal ICP intracranial hematoma ischemic stroke tumor abscess other...
If a pt has a thunderclap headache (no headache one second, next second terrible headache) what do you think about?
aneurysmal rupture cerebral sinus thrombosis acute intracranial hypotension carotid artery dissection pituitary apoplexy unruptured aneurysm sexual headache crash migraine** most common cause
What makes you worry in this clinical case:
19 yo Female university coed reports 10 years of episodic, left-sided, pulsatile headache often heralded by “sparkles & blind spots” in the right periphery of vision. Her previously effective abortive therapy no longer helps.
one-sided headache
**this is a primary astrocytoma or oligodendroglioma in the occipital lobe causing partial seizures
Most common diagnosis for patient presenting with headache in the ER?
migraine
- *94% of elective visits for CC of headache
- *if recurrent attacks of disabling headache, think migraine first
Should you do brain imagining on a pt with a migraine, who has a history of migraine but normal neuro exam?
no
How do you identify a secondary headache in the ER?
acute onset
age >55
occipto-nuchal location
abnormal exam
5 or more attacks: unprovoked 4-72hr duration prohibit/significantly inhibit routine activities nausea and/or photo/sonophobia
migraine
What causes migraine?
genetically-induced neuronal hypersensitivity
Where are receptors for head pain located?
on the dural blood vessels –> travels on CN5
T/F: There are epigenetic factors that contribute to likelihood of having migraines. Ex: if you experience child abuse, you are more likely to have migraine headaches.
True
What area of the brain might you target to decrease the hypersensitivity associated with migraine?
trigeminal nucleus caudalis
**this area receives afferent messages and acts as a sensory relay center
Why can anti-epileptic drugs work for migraines as well?
GABA-nergic transmission suppresses the hypersensitivity of neurons
**Topamax or Depakote
Things that can be used for acute migraine treatment?
NSAIDS
triptans
ergotamines/dihydroergotamine
opiates/opioids
Only FDA therapy approved for chronic migraine
Botox
**beta blockers, TCAs, anti-epileptic drugs can be used, too
