Final Exam -- Headaches--Part I Flashcards Preview

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Flashcards in Final Exam -- Headaches--Part I Deck (40)
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1
Q

Nearly 90% of headaches fall into one of these categories: migraine, tension-type, chronic daily, and cluster. Which of these types of the most commonly diagnosed?

A

Migraine

2
Q

Nearly 90% of headaches fall into one of these categories: migraine, tension-type, chronic daily, and cluster. Which of these types of the most frequent?

A

Tension-type

3
Q

Headache danger signs are symptoms which may indicate a serious underlying cause of the headache. These can be remembered by the acronym SNOOP. What does the S stand for?

A

Systemic symptoms–fever, weight loss, cancer, immunocompromised, pregnant

4
Q

Headache danger signs are symptoms which may indicate a serious underlying cause of the headache. These can be remembered by the acronym SNOOP. What does the N stand for?

A

Neurologic symptoms–confusion, impaired consciousness, bilateral optic disc swelling, seizures

5
Q

Headache danger signs are symptoms which may indicate a serious underlying cause of the headache. These can be remembered by the acronym SNOOP. What do the O’s stand for?

A

Onset is new (especially if over age 40*)

Other associated features–head trauma, drug use, pain worse with posture changes

6
Q

Headache danger signs are symptoms which may indicate a serious underlying cause of the headache. These can be remembered by the acronym SNOOP. What does the P stand for?

A

Previous headache with history of progression–change in frequency, duration, intensity

7
Q

Besides SNOOP, what are the two headache danger signs mentioned in class?

A

“First or worst” headache*

Headaches not reponding to treatment

8
Q

If a patient has a danger sign for a headache, imaging should be done, and typically an MRI is preferred over a CT (though CT is preferred in emergencies). Lumbar puncture should be performed if you are suspicious for either of what two conditions?

A

Meningitis or subarachnoid hemorrhage

9
Q

Migraine headaches affect activities of daily living, are ___________ (unilateral/bilateral) and typically occur how many times per month?

A

Unilateral, 1-4 times per month or less.

10
Q

There were three types of migraine headaches discussed in class: without aura, with aura, and aura without headache (acephalgic). Which of these is the most common type?

A

Migraine without aura.

11
Q

Comparing migraine with aura to migraine without aura, which requires at least five attacks for diagnosis?

A

Migraine without aura.

12
Q

Comparing migraine with aura to migraine without aura, which requires at least two attacks for diagnosis?

A

Migraine with aura

13
Q

The diagnostic criteria for a migraine without aura includes the headache lasting how long?

A

4 to 72 hours

14
Q

The diagnostic criteria for a migraine without aura includes a headache with at least two of which four characteristics?

A

Unilateral location
Pulsating quality
Moderate or severe pain
Aggravation caused by routine physical activity (or headache causing avoidance or routine physical activity).

15
Q

To be diagnosed as migraine with aura, the aura symptom(s) must be fully reversible. Two of what four characteristics must be present?

A

At least one aura symptoms spreading gradually over more than 5 minutes (and/or two or more symptoms occurring in succession)
Individual aura symptoms last 5 to 60 minutes
At least one aura symptom is unilateral
Aura accompanied by or followed within 60 minutes by a headache

16
Q

The cortical spreading depression (CSD) theory of migraine pathophysiology states that aura are caused by a wave of excitation in parts of the brain. CSD is also said to activate the trigeminal system* and cause release of what neuropeptides?

A

Calcitonin gene-related peptide (CGRP)*
Substance P
Neurokinin A

17
Q

The cortical spreading depression (CSD) theory of migraine pathophysiology states that aura are caused by a wave of excitation in parts of the brain. The permeability of the blood-brain-barrier is affected by what inflammatory markers?

A

COX-2, TNF-alpha, MMPs

18
Q

True or false: the cortical spreading depression theory (CSD) states that nociceptor threshold is increased, and the magnitude of their response is increased as well.

A

False; the threshold is decreased (easier to feel pain), and the magnitude is increased

19
Q

Migraines are associated with depletion of which endogenous substances? With excess of which substance?

A

Depletion of serotonin and estrogen; excess dopamine.

20
Q

There are lots of possible triggers for migraines. Which three were bolded on the list in class?

A

Emotional stress, hormones in women, not eating/hunger.

21
Q

A prodrome to a migraine occurs between 24-48 hours prior to the headache and involves what types of findings?

A

Depression, irritability, food cravings, neck stiffness, yawning, fatigue, difficulty concentrating, aversion to light, sounds, smells.

22
Q

The most common type of aura is visual. It occurs over 5 minutes and may be a zig-zag pattern or a shimmering scintillating appearance. It may be a C-shaped and will leave a central scotoma

A

Free card.

23
Q

True or false: the typical migraine headache lasts less than a day, is uilateral and involves a throbbing or pulsatile pain.

A

Mostly true–the duration can be anywhere from 4 hours to several days (so not necessarily “typically” less than a day)

24
Q

____________________ is the perception of pain due to normally non-painful stimuli and can occur with a migraine.

A

Cutaneous allodynia

25
Q

How would you treat a mild to moderate acute migraine?

A

NSAIDs or acetaminophen

26
Q

How would you treat a moderate to severe acute migraine?

A

Triptans or a combination of triptans and NSAIDs

27
Q

How would you treat an extremely severe acute migraine?

A

Subcutaneous sumatriptan, IV/IM antiemetic with diphenhydramine or dihydroergotamine, IV/IM ketorolac or dexamethasone

28
Q

True or false: narcotics and opioids are good treatment options for acute migraines.

A

False; they are not recommended.

29
Q

For acute therapy, treatment should start within how long of the onset of the migraine symptoms?

A

15 minutes

30
Q

Over the counter acute therapy for migraines involves NSAIDs or acetaminophen, or Excedrin (combination of acetaminophen, caffeine, and aspirin). True or false: a large single dose is more effective than multiple smaller doses.

A

True.

31
Q

Triptans are used to treat acute migraines and are agonists of __________.

A

Serotonin

32
Q

True or false: when using triptans to treat an acute migraine, they should be taken early on, but not more than 3 times per week*

A

True.

33
Q

Which triptan is available as a patch?

A

Sumatriptan*

34
Q

Besides triptan treatment for acute migraines, you can use a triptan/NSAID combo, or dihydroergotamine.

A

Free card.

35
Q

Which drug for migraines is preferred for anti-emesis?

A

Metoclopramide*

36
Q

True or false: Prevention of migraines can be done with beta agonists.

A

False; it can be done with beta blockers.

37
Q

Prevention of migraines can be done with antidepressants like _________ and __________.

A

Amitriptyline and venlafaxine

38
Q

Prevention of migraines can be done with anticonvulsants like valproate (also used for ________ seizures), lamotrigine (also used for __________ seizures), and topiramate (which has what side effects?).

A

Valproate: general seizures
Lamotrigine: focal seizures
Topiramate: causes angle closure and myopic shift

39
Q

Prevention of migraines can be done with a calcium channel blocker like _________ .

A

Verpamil

40
Q

Avoiding triggers of migraines, getting regular sleep, regular meals, and regular exercise, and keeping a headache diary can all help with migraine management. What two other options were listed in lecture?

A

Acupuncture and transcutaneous electric nerve stimulation (TENS)