Neurology 2 > Clin Med - Headache > Flashcards

Clin Med - Headache Flashcards

(75 cards)

Study These Flashcards
1
Q

What 7 factors must you determine for each type of HA

A
  1. frequency
  2. duration
  3. intensity
  4. type of pain (throbbing, sharp, etc.)
  5. Presence of GI sx
  6. Visual sx (aura)
  7. other neuro sx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is one of the most important diagnostic tools for HA

A

History

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Other neuro sx common associated with HA

A
  • tinnitus
  • hearing loss
  • dysarthria *
  • dysphagia *
  • weakness *
  • sensory loss *
  • LOC *
  • aphasia/dysphasia *

*could be signs of emergent condition (stroke, aneurysm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Headache intensity classification

A
  • disabling: can’t get out of bed
  • severe: limits activity 50-90%
  • moderate: limits activity 25-50%
  • mild: does not limit activity at all
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

6 types of HA

A
  • migraine
  • tension
  • cluster
  • HA with head trauma
  • HA with vascular disorders
  • HA with nonvascular intracranial issue
  • HA with substance abuse/withdrawal
  • HA with infection (meningitis)
  • metabolic HA
  • HA from cranial structure
  • cranial neuralgia
  • other facial pain
  • psychogenic HA
  • HA: not otherwise classified
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Two types of HA classified by cause

A
  1. primary - idiopathic

2. secondary - organic, related to other disease state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Two types of secondary/organic HA

A
  • intracranial

- extracranial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Three types of primary HA

A
  • migraine
  • cluster
  • tension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Common causes of secondary HA

A
  • toxic (CO poisoning)
  • metabolic
  • vascular
  • infectious
  • tumor/mass lesion
  • trauma
  • heredo-degenerative
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is very important in diagnosis toxic exposure HA

A

HISTORY

  • exposure
  • profession (exposure)
  • etc.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Examples of toxic causes for HA

A
  • organic compounds: solvents, drugs
  • inorganic compounds: lead, arsenic, cadmium, etc.
  • gases and fumes: H2S, CH4, CO, H2O, formaldehyde
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Drugs that cause HA

A
  • oral contraceptives
  • nitro
  • fluoxetine
  • opioid pain meds
    MANY others
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of metabolic HA

A
  • renal failure
  • hepatic failure
  • acidosis
  • alkalosis
  • CO2 retention
  • anemia
  • hypo- and hyperthyroid
  • cushing
  • hyperparathyroid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Vitamin deficiency cause of HA

A
  • Niacin - pellagra
  • Thiamin - beri beri
  • vitamin C - scurvy
  • B12 - combined system disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

One common cause of infectious HA

A

meningitis

- history and PE important to look for other sx of meningitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Parenchymal infectious causes of HA

A
  • bacterial
  • brain abscess
  • spirochete: syphilis
  • viral
  • HIV
  • fungal
    etc etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Extracranial mass lesions that can cause HA

A
  • sinus carcinoma
  • mastoid tumor - cholesteatoma
  • head and neck carcinoma
  • carotid body tumor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Migraine epidemiology

A
  • F>M
  • onset generally 2nd or 3rd decade of life
  • fam history common
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Migraine pathophys

A
  • exact mechanism unknown
  • maybe dt genetic abnormality that makes neuromuscular system hyperexcitable
  • a trigger is usually involved
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What happens when a trigger activates a migraine?

A
  • cortical spreading depression which may or may not lead to aura
  • release of neuropeptides (serotonin, cytokines, etc.) which bind to intracranial blood receptors = vasodilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Common migraine triggers

A
  • red wine
  • skipping meals
  • excessive afferent stimuli (flights, odors)
  • weather changes
  • sleep deprivation
  • stress
  • hormonal factors
  • certain foods
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Two types of migraine

A
  • migraine with aura (25%)

- migraine without aura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When does aura occur during migraine phase?

A
  • can proceed migraine

- during migraine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

characteristics of a aura headache

  • development
  • how long last
A
  • gradual development

- last less than one hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Positive migraine aura symptoms
- visual (bright lines, shapes, objects) MC - auditory (tinnitus, noises, music) - somatosensory (burning, pain, paresthesia) - motor (jerking, repetitive rhythmic movements)
26
Negative migraine aura symptoms
- absences or loss of function | - loss of vision, hearing, feeling, ability to move part of body
27
Most common sx of migraine
- pain - photophobia - phonophobia - nausea
28
Visual sx of migraine
- scintillating scotoma (MC) - blurred vision - visual loss - diplopia * * and many less common features
29
Mood/behavior changes due to migraine
- mood changes - irritability - depression - euphoria *before, during, after migraine
30
Things to consider when dx-ing migraine
- TIA - CVA - intracranial hemorrhage - hypoglycemia MANY MORE
31
Diagnostic criteria for migraine without aura
5 attacks of the following: - untreated HA lasts 4-72 hours Plus two of the following: - Unilateral - pulsating - moderate/severe pain - exacerbated by physical activity Plus at least one during HA: - n/v - photo- or phonophobia
32
Diagnostic criteria for migraine with aura
Two attacks of the following: - One or more reversible aura symptoms (visual, sensory, speech/language, motor, brainstem, retinal) - Two of the following characteristics: - one aura sx >5 minutes or 2 or more sx in succession - at least one aura sx is unilateral - ea aura sx lasts 5-60 min - aura is accompanied by or followed by HA within 60 min
33
Is imaging necessary to dx migraine?
Nope!
34
When is imaging necessary necessary when pt presents with non-acute HA
- unexplained abnormal finding on neuro exam | - atypical HA features
35
What HA sx warrant imaging?
- sudden and severe - "first or worst" - recent significant change in pattern, frequency, severity - new or unexplained neuro sx or signs - HA always on same side - HA not responding to tx - new onset HA after age 50 - new onset w/ HIV or cancer - sx: fever, stiff neck, papilledema, cog impairment, personality change
36
What imaging to order for HA?
- CT w/o contrast (1st to ro bleeding) - MRI - MRA (vascular issues)
37
First line tx for mild/moderate attacks
- simple analgesics (NSAIDs or acetaminophen) | - antiemetic for n/v
38
First line tx for moderate to severe attacks without n/v
- oral migraine specific meds (triptans)
39
First line tx for mod to severe attacks with n/v
non-oral migraine specific meds - sub q sumatriptan - nasal sumatriptan non-oral antiemetics - topical or rectal phenergan - parental dihydroergotamine (DHE)
40
Meds to consider when treating migraine in the ER
(usually severe by time reach ER) - sumatriptan subq - dihydroergotamine (DHE) - antiemetics (metoclopramide, prochlorperazine, chlorpromazine) - ketorolac
41
what type of meds should be avoided in migraine tx
- opioids | - barbituates
42
Rebound headache/medication overuse HA (MOH) - which meds possible - which meds most likely? - which meds lowest risk
- all acute symptomatic meds have potential - risk highest in opioids, butalbital containing analgesics, aspirin/acetaminophen/caffeine combos - triptans moderate risk - NSAIDS lowest risk
43
how to prevent MOH
- acute meds limited to < 10 days per month or <15 days for NSAIDs
44
simple analgesics
- NSAIDs - aspirin - ibuprofen - naproxen - diclofenac - ketorolac - acetaminophen
45
HA dt temporal arteritis
- severe HA | - recurrent/persistent over weeks to months
46
Temporal arteritis - dx - tx
- elevated ESR and CRP and temporal artery biopsy | - high dose steroids and NSAIDs
47
Presentation of cluster HA
- brief, severe, constant - non throbbing - 10 min to < 2 hours - unilateral, return to same side - begins as burning behind eye
48
What HEENOT sx do cluster HA present with?
- conjunctival injection - tearing - nasal stuffiness - ipsilateral Horner's syndrome
49
what can precipitate cluster HA
- alcohol | - vasodilation drugs
50
Dx of cluster HA
- hx and PE to r/o other causes of HA
51
Cluster HA tx
- 100% O2 via nonrebreather - sumatriptan IM or nasal spray - dihydroergotamine
52
Tension HA - how common? - pathophys - men vs. women
- most common benign HA disorder - no pathophysiologic mechanism - W > M
53
Tension HA location | - often associated with what?
- neck, back of neck, top of head | - often assoc. with neck pathology (degenerative disk dz, etc.)
54
What is very important in dx of tension HA?
- history of PE | - necessary to r/o more ominous dx and/or to determine underlying condition causing HA
55
What is common cause of tension HA that can be found in history?
- often secondary to analgesic overuse | - thoroughly address efforts at medical management!
56
Tension HA presentation
- steady, nonthrobbing - bilateral - global head pain - not associated with prodrome, neuro signs/sx or n/v
57
What are CT findings fro tension HA?
usually normal CT :)
58
Tension HA tx
- similar tx to other HA (triptans, anti-inflammatories) with possible addition of a muscle relaxer
59
Non pharm tx for tension HA
- psychotherapy - PT - muscle relaxants - relaxation techniques
60
GCS
memorize if you wish
61
Concussion | - overview
- head injury due to contact and/or acceleration or deceleration forces - cortical contusion - can be coup contrecoup
62
Hallmark sx of concussion
- confusion - amnesia - +/- LOC ** assess duration to assess severity of injury (and risk of complications)
63
Early sx of concussion
(minutes to hours) - HA - dizziness - lack of awareness of surroundings - n/v
64
late sx of concussion
(hours to days) - mood or cognitive disturbances - sensitivity to light and noise - sleep disturbances
65
Other sx of concussion
- vacant stare - delayed verbal expression - inability to focus - disorientation - slurred/incoherent speech - gross incoordination - emotions out of control - memory deficits - LOC *can show up 2-3 days after injury, educate family!
66
Concussion Dx
- Head CT w/o contrast
67
Concussion: when to order a CT
- GCS < 15 two hours after injury - suspected open/depressed skull fx - signs of basilar skull fx - >2 vomit - >65 yo - amnesia before impact > 30 min - neuro deficit - seizure - use of anticoagulants
68
Concussion tx
- monitored at home X 24 hours
69
When to return to ER after concussion
- inability to awaken pt - severe/worsening HA - confusion/somnolence - restlessness/unsteadiness - seizure - vision change - vomiting, fever, stiff neck - urinary or bowel incontinence - numbness/weakness
70
Post concussion syndrome sx
- seizures (MC) - HA - dizziness - neuropsychiatric sx - cognitive impairment - depression - anxiety - PTSD *does not require LOC
71
Post concussion syndrome Dx
- neuropyschological testing | - neuroimaging (CT, MRI, EEG)
72
Post concussion syndrome CT
- 10% show abnormal bleed, mild subarachnoid hemorrhage, subdural hemorrhage, contusion
73
Post concussion syndrome MRI
- more sensitive than CT | - shows abnl in 30% pts with normal CT
74
Post concussion syndrome Tx
- migraine meds - analgesics - psych counseling - psychotropic meds
75
Post concussion syndrome recovery
- most recover quickly within several weeks | - minority have prolonged disability
Neurology 2
flashcards
Decks in class (21)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions