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CDM II Fall Block > Eval of HA - Jaynstein > Flashcards

Eval of HA - Jaynstein Flashcards

1
Q

Whats the classic for SAH

A

Maximal intense

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2
Q

T/F Migraine will start off slow and increase

A

True

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3
Q

What is the 8th most common PCP complaint?

A

HA

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4
Q

Is there a strong genetic component with HA?

A

yes!

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5
Q

What is primary HA vs secondary HA?

A

Primary is from independently rather than from another medical issue

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6
Q

What are examples of primary HA?

A

Tension, migraine, cluster

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7
Q

What is secondary HA?

A

Ha from another issue

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8
Q

What is example of secondary HA?

A

Infection
Trauma
Stroke syndromes
REBOUND

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9
Q

What is approach to HA?

A
  • Good H&P
  • If secondary then you can do work up
  • If primary HA then deduce type of HA
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10
Q

What kind of infection cause HA?

A

sinusitis, meningitis, encephalitis

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11
Q

What kind of vascular cause HA?

A

CVA or TIA, SAH, dissections, temporal arteritis

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12
Q

What kind of CSF cause HA?

A

Spinal HA, pseudotumor cerebri

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13
Q

What are other causes of HA?

A

post-seizure, preeclampsia, intracranial mass

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14
Q

T/F You can’t dx the migraine until pt meets the criteria

A

True

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15
Q

T/F Patients who have headaches secondary to a serious underlying cause usually have distinct historical or exam findings

A

True

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16
Q

Whats age is a red flag in HA?

A

New HA in pt over 50 is bad until proven other wise

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17
Q

What are vascular sx that is red flag?

A

standing, lying down, valsalva, cough, or sexual activity

Can be due to elevated CSF, papilledema

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18
Q

If there is evidence of systemic/secondary HA they need what?

A

They need neuro imaging!

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19
Q

Is it common for kids to get random HA?

A

No its scary complaint

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20
Q

What sx is to the ER?

A
  • Worst HA of life (SAH, CNS infection)
  • Sudden onset reaching severe, maximal intensity within minutes - Thunderclap Headache – (ICH, meningitis)
  • Rapid onset with strenuousexercise (SAH, carotid artery dissection)
  • Neuro deficits, LOC, AMS
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21
Q

What kind of pt needs further workup?

A
  • Age < 5 or > 50 with no prior headache history (mass lesion)
  • Progressive in frequency or severity (medication misuse, subdural hematoma, mass lesion)
  • HA awakens pt from sleep
  • Change in HA pattern
  • Systemic symptoms – fever, neck stiffness
  • Temporal artery tenderness
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22
Q

what is systemic symptoms indicated for and can’t miss?

A

meningitis

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23
Q

what kind of PE should you do with HA?

A
  • Blood pressure
  • Fundoscopy
  • Auscultation for bruits
  • Temporal artery inspection and palpation
  • Meningismus
  • Neurologic exam: motor, sensory, coordination and gait
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24
Q

Should you get labs for primary HA?

A

Nope

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25
Q

What kind of pt should get neuroimaging? CT w/o contrast is the 1st line

A
  • Focal neurological signs
  • Onset of headache with exertion or sexual activity
  • Worst HA of life
  • CHI with LOC or on anticoagulants
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26
Q

T/F Research has shown that HA diaries/logs are more helpful for clinicians than labs or imaging in most cases

A

True

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27
Q

What are the characteristics of migraine

A
  • HA lasting 4-72 hrs
  • Unilateral pain
  • Throbbing pain
  • HA worsens with exercise/activity
  • Moderate to severe pain
  • Associated N/V
  • Light and sound sensitivity
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28
Q

What is the most common HA?

A

Tension

29
Q

Which HA causes the most disability?

A

Migraine

30
Q

If they have auditory HA what should you do

A

get psych??

31
Q

What is treatment of migraine?

A
32
Q

T/F Earlier you tx migraine, the better it is?

A

True!!

33
Q

Episodic HA can progress into what if we dont tx it?

A

Chronic HA syndrome

34
Q

What should you do with migraine tx?

A
  • To decrease the number of days pt has HA rather than set the expectation of no HA’s ever
  • Set limit to the number of HA related visits for pain control (2/month)
35
Q

What is the tx of goal for migraine?

A
  • Treat HAs promptly
  • Limit HAs to two hours or less
  • Optimize out pt treatment
  • Reduce healthcare costs – decrease ER visits
  • Minimize adverse SE of meds
  • Minimize use of narcotics
36
Q

What are some preventative medications?

A
  • Antidepressants
  • Anticonvulsants
  • Beta-blockers
  • CCB
37
Q

Which is the best preventative for ppx migraine?

A

Bblocker

38
Q

What are the 1st line abortive medications?

A

NSAIDs, APAP, ASA, Excedrin, Tordol

Start 1st line

39
Q

Whats best meds for otc?

A

Excedrin

40
Q

Whats in excerdrin?

A

Caffeine, APAP and ASA

41
Q

What is s/e for tordol been linked with?

A

Renal failure

42
Q

What is the most effective DOSE for ibuprofen for pain relief? (not anti-inflammatory)

A

400mg, nothing bigger!

43
Q

T/F all nsaids have therapeutic ceiling

A

True

44
Q

What is black box of tordol?

A

?

45
Q

Should you give them triptans right away?

A

Yes, if you think its migraine

46
Q

Does triptans need dx for migraine?

A

No, does not need dx for us to prescribe

47
Q

What are abortive medications?

A

NSAIDs, APAP, ASA, Excedrin, Tordol
Triptans – Sumatriptan (Imitrex)
Combinations – butalbital/APAP/caffeine (Fioricet)
DHE
Narcotics

48
Q

Can you use narcotics for abortive?

A

you cant but plz don’t

49
Q

Whats the tx for mild-moderate migraine?

A

OTC analgesics, including nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, acetaminophen, and combinations containingcaffeine

50
Q

Caffeine containing meds at risk for what?

A

more effective but also have a higher risk of bringing on rebound headaches

51
Q

What do aura put pts at most risk for?

A

Heart attack and occipital stroke

52
Q

Why could aspirin be a good choice?

A
  • Cardioprotective rather than increasing cardiovascular risks, as most NSAIDs do
  • Caution in patients whom you suspect SAH!
53
Q

Who can benefit from migraine tx?

A
  • more than one day HA per week
  • Miss work bc of HA
  • Associated complex symptoms
54
Q

How long will migraine tx take to be effective?

A

8-12 weeks

55
Q

What are good OTC tx to prevent migrain?

A
  • Petadolex (adult and children)
  • Magnesium supplements
  • Coenzyme
56
Q

Can you put aspirin for HA ppx?

A

NO!

57
Q

Pt with migraine with aura, estrogen BC, what are they at risk for?

A

Stroke

58
Q

What causes rebound HA?

A

recurring headache that is induced by repetitive and chronic use of acute medications.

59
Q

T/F Acute med is ineffective in Rebound HA

A

True until medications have been withdrawn and washout or medication withdrawal occurs.

60
Q

T/F Nearly all med used to treat HA can lead to rebound

A

True

61
Q

What are common lifestyles triggers for HA?

A
  • Emotional stress, depression, too little sleep, exercise or overactivity, skipping meals/fasting
62
Q

What are common lifestyle food triggers for HA?

A

Chocolate, nuts,peanut butter, cheese, yogurt, sour cream, red wine, processed meat, MSG

63
Q

What are common phsyical triggers for HA?

A

Menstrual cycle/hormonal changes

64
Q

What are common environmental triggers for HA?

A
  • Weather or seasonal changes
  • Travel through different time zone
  • Odors/pollution
  • Bright light
65
Q

What are the pitfalls to HA?

A
  • Misdiagnosing migraine
  • Over treating HA with medication linked to rebound HA
  • Under-treating migraine, limit of abortive treatment in lieu of analgesic
  • Blaming HA solely on stress
66
Q

When to refer pt w/ chronic HA’s?

A

Most pt w/ HA, chronic, can be managed in PC

67
Q

When to refer pt w/ chronic HA’s?

A

Consider obtaining a head CT (if not already done) and sending to neuro if:
- <5 or >50 years old
- Progressive headaches despite treatment
- History of cancer
- Uncertain dx

68
Q

Whats the best drug in HA cocktail that Jaynstein?

A

Benadryl, compazine and tordol

69
Q

Whats the most common s/e of zofran?

A

Prolonged QT

CDM II Fall Block (9 decks)

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