[CLMD] Headache [Hon]

Question 1

What are the two general categories of headaches?

Answer 1

Primary headaches (benign HA disorders)

Secondary headaches (HA sign of organic disease)

Question 2

What is important to aquire during a history of headaches?

Answer 2

Pain

• Intensity
• Location
• Duration
• Impact of exertion

*NOT JUST THE WORST HEADACHES, all of the headaches the patient gets

Question 3

What is contained in a prodrome?

Answer 3

Before onset of HA

• Changes in energy levels
• Fatigue
• Muscle aches

-Aura

Question 4

What are some unique associated symptoms with headaches?

Answer 4

N/V

Anorexia

Photophobia

Phonophobia

Dizziness

Ptosis/miosis

Watery eyes

Question 5

What are common HA triggers?

Answer 5

Stress

Hormones

Diet

Enviornmental changes

Sensory stimuli

Question 6

What are some of the worrisome signs associated with HA?

(pathoogical origin)

Answer 6

• “Worst HA”
• Onset of HA after age 50
• Atypical HA for patient
• HA with fever

-Abrupt onset

• Subacute HA with progressive worsening over time
• Drowsiness, confusion, memory impairment
• Weakness
• Abnormal neurological/medical exam

Question 7

Define: Meningitis

Answer 7

Inflammation of the meninges surrounding brain and spinal cord, sometimes with associated encephalitis

Question 8

What is the most common cause of bacterial meningitis in nearly all age groups?

Answer 8

Streptococcus pneumoniae

Question 9

What is the most common cause of bacterial meningitis in the elderly?

Answer 9

Listeria monocytogenes

Question 10

What is the most common cause of bacterial meningitis in teenagers and young adults?

Answer 10

Nisseria meningitidis

Question 11

What is the most common cause of bacterial meningitis in unvaccinated children?

Answer 11

Hemophilus influenza

Question 12

Symtpoms of meningitis?

Answer 12

Sudden high fever

Stiff neck

Severe HA

Confusion or difficulty concentrating

Seizures

Skin rash

Question 13

How do you treat acute bacterial meningitis?

*TEST QUESTION*

Answer 13

IV steroids

• Dexomethasone
• Ceftriaxone
• Vancomycin

Question 14

Define encephalitis

Answer 14

The presence of an inflammatory process of the brain in association with clinical evidence of neurological dysfunction

Question 15

What are the common causes of infectious encephalitis in an adult?

Answer 15

VIRUSES

• HSV 1/2
• HIV
• West Nile
• Varicella zoster
• Treponema pallidum

Question 16

What is the issue with the presentation of herpes simplex 1 encephalitis for diagnosis?

Answer 16

The clinical presentation is VERY SIMILAR to meningitis.

If you are unsure about the diagnosis, JUST ADD ACYCLOVIR (IV)

Question 17

What type of encephalitis can mimic infectious encephalitis?

Answer 17

Autoimmune encephalitis

Question 18

What are autoimmune encephalitis cases usually associated with?

Answer 18

SEIZURES

Question 19

What is important in the treatment of patients with autoimmune encephalitis?

Answer 19

INITIATION OF TREATMENT

While you are awaiting test results, best to have the treatment already initiated

Question 20

How do you treat autoimmune encephalitis?

Answer 20

High dose steroids

IVIg

Plasma exchange

Immunosuppresive agents

Question 21

What are the two known etiologies of autoimmune encephalitis?

Answer 21

NMDA encephalitis

LGI1 encephalitis

Question 22

NMDA Encephalitis

Gender?

Age?

Onset speed?

Answer 22

Gender = Women

Age = young/middle aged

Onset speed = rapid onset (less than 3 months)

Question 23

What are the clinical symptoms of NMDA encephalitis?

Answer 23

Abnormal psychiatric behavior

Speech dysfunction

Seizures

Movement disorder

Decreased level of consciousness

Central hypoventilation

Question 24

What are the abnormal lab results with NMDA encephalitis?

Answer 24

Abnormal EEG (extreme delta brush)

CSF (pleocytosis or oligoclonal bands)

Question 25

What is a common association with **NMDA encephalitis?**

Answer 25

Teratoma

Question 26

LGI1 Encephalitis Gender?

Answer 26

Male

Question 27

What is the hallmark seizure associated with **LGI1 encephalitis?**

Answer 27

Faciobrachial dystonic seizures

Question 28

Describe what a **faciobrachial dystonic seizure** would look like

Answer 28

Brief seizures Involve one side of the face, and the arm on the **same side** Occurs frequently, hundreds of times per day \*\*\*DO NOT RESPOND TO ANTIEPILEPTIC DRUGS ALONG

Question 29

What is the general rule for imaging with a **HA**? "Worrisome history"?

Answer 29

One-time thorough neuroimaging study Urgent imaging study and **L.P,** possibly **arteriogram**

Question 30

Definition of: Common migraine = Classic migraine =

Answer 30

Common migraine = Migraine without aura Classic migraine = Migraine with aura

Question 31

Migraine info not included in fc

Question 32

What is considered **chronic migraine?**

Answer 32

With HA **15 or more days per month**, HA lasting **4 hours or longer**

Question 33

What is the most widely discussed theory for migraine cause?

Answer 33

Neurogenic inflammation

Question 34

Typical location of **tension type HA?**

Answer 34

Bifrontal Bioccipital Neck Shoulders Band like

Question 35

Cluster HA Intensity? Association?

Answer 35

Intensity = SEVERE, EXCRUCIATING Association = Obstructive sleep apnea

Question 36

Cluster HA Location? Unilateral/Bilateral?

Answer 36

Location = Orbitotemporal Unilateral/Bilateral = ALWAYS UNILATERAL

Question 37

What is an excellent treatment for migraines?

Answer 37

Triptans

Question 38

What are the major contraindications to triptan use?

Answer 38

Cardiovascular disease Raynauds use with MAOIs or other 5HT1 agonists

Question 39

What do you go to for chronic migraine treatment if all other pharmacologic treatments dont work?

Answer 39

BOTOX injections

Question 40

What is **trigeminal neuralgia?**

Answer 40

Excruciating sharp, shooting, electrical quality pain In the face

Question 41

Treatment for **trigeminal neuralgia?**

Answer 41

Carbamazepine Oxcarbazepine

Question 42

What is **SUNCT syndrome?**

Answer 42

Shortlasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing

Question 43

Paroxysmal hemicrania Similar to? Difference? Responsive only to?

Answer 43

Similar to = cluster HA Difference = shorter duration Responsive only to= indomethacin