Flashcards in HA 2 Deck (64)
What is needed to diagnose a sinus HA?
-Purulent nasal d/c
-Pathological sinus findings on imaging
True or false: chronic sinusitis is a cause of sinus HA
False--does not count for diagnosis unless progresses into an acute episode
Activation of the TNC results in what?
Activation of cranial PNS nerves extending into the sinus cavities and tear ducts
True or false: sinus pressure and symptoms are not usually associated with migraines
What is the most common HA that is seen by the neurologist?
What is the acute treatment for migraines?
What is the rescue therapy for migraines HAs?
What is the MOA of triptans?
5HT agonists to selectively constrict the meningeal arteries by blocking the release of vasoactive peptides
What are the FDA approved drugs for migraine prevention? (3)
What is the use of botulinum toxin in treating migraines?
Prophylactically for chronic migraine suffers
What is the "indication" for butterbur? Side effects?
What are the supplements for migraine prophylaxis?
-High dose B2
True or false: gabapentin is only used for acute attacks of migraines
What is the diuretic that may help with migraine prophylaxis?
What type of antidepressants are used for migraines?
What are the three major TCAs?
The use of abortive treatments for migraines should be limited to how many times per week? Why?
Avoid the development of rebound HAs
What may happen with numerous, untreated migraines?
Increase in frequency, duration, and severity d/t changes in pain generators
How long does it take for migraine prophylaxis to be effective?
What is the pathophysiology of Trigeminal Autonomic Cephalgias (TACs)?
Activation of the trigeminal autonomic reflex that causes "allergy" symptoms on the side of the reflex
What are the characteristics of cluster HAs?
Piercing, unilateral stabbing pain, accompanied by ipsilateral lacrimation and nasal congestion
Which gender is usually affected with cluster HAs?
How often do cluster HAs recur? When in the day do they usually occur?
1-10 attacks per day, usually at night
How long do episodes of cluster HAs happen?
What is the seasonal pattern of cluster HAs?
usually in the fall and spring
What is the prophylactic treatment for cluster HAs?
What is the bridge therapy for cluster HAs for the prophylactic meds to kick in?
Starting dose of oral steroids
What is paroxysmal hemicrania?
Cluster HAs that usually occur a ton per day--up to 40 times/day
What is the diagnostic criteria for paroxysmal hemicrania?
HA has to abort with indomethacin use
What is SUNCT?
Short-lasting unilateral neuralgiform HA with conjunctival injection and tearing
What are the s/sx of SUNCT?
Similar to trigeminal neuralgia, but with ipsilateral ANS s/sx
What is hemicrania continua? Treatment?
-HA that is constant 100% of the time, with associated ipsilateral ANS s/sx
What is a chiari malformation?
Posterior fossa contents that slip through the foramen magnum--congenital malformation
What percent of HA in HA clinics are d/t medication overuse?
What is the most important risk factor for chronic daily HA?
What are the characteristics of analgesic overuse HAs? (Bilateral or unilateral? Character? Intensity?)
What is combination medication overuse HA?
-Same as analgesic overuse HA except intake of combination meds for more than 10 day/month for 3+ months
What is the diagnostic criteria for Combination MOH?
Same as MOH HAs, but:
-Intake of combination medication on more than 10 days/month for 3 months
What is the pathophysiology of MOH HAs?
Continued use of analgesics upregulates 5HT receptors, leading to a lower threshold for HA development
What is the frequency of MOHs?
Daily or nearly daily
What are the accompanying s/sx of MOH HAs?
What type of HA usually causes med overuse?
Why is it necessary to choose the most efficacious med for HAs?
Use of suboptimal medications leads to increased usage
What were the results of the head-HUNT study, in terms of the increased risk for migraines and non-migraines with medication overuse?
-Relative risk of chronic migraine elevated by 13.3 times
-risk of chronic non-migraine HA elevated 6.2 times
True or false: when migraines patients with a non-headache medical condition take analgesics daily for that condition, they can develop MOH
What is the role of barbiturates in HA?
No studies that prove or refute the efficacy for butalbital-containing agents in the treatment of acute migraines HAs
What is the role of opioids in the treatment of HAs?
Better reserved for use when other meds cannot be used or when sedation effects are not a concern
What is the role of the trigeminal nucleus caudalis?
Pain input nucleus in the trigeminal pathway
What is the role of the mesencephalic nucleus of the trigeminal nerve?
Proprioception of the face
What is the trigeminal autonomic reflex?
Since the Trigeminal nucleus caudalis lies adjacent to the superior salivatory nucleus, there is cross communication, leading to HAs
What are the contraindications for triptans?
Anything where you want to avoid constriction of arteries
What is the definition of migraines? Treatment?
15 or more migraines / month for more than 3 months
Quarterly botox injections
What is the most common manifestation of TACs?
What is the acute therapy for cluster HAs? (3)
What is the primary prophylactic therapy for cluster HAs? What should always be checked, prior to administering this?
EKG should be obtained
What is the diagnostic criteria for hemicrania continua?
Must resolve with indomethacin administration
For the diagnostic criteria of AOH, a HA has to be present for how many days /month?
For the diagnostic criteria of AOH, the intake of analgesics has to be equal to or greater than what amount? For how long?
More than 15 days/month for 3 months
For the diagnostic criteria of AOH, what has to happen to the severity of the HA with analgesic use?
For the diagnostic criteria of AOH, the HA has to resolve within what timeframe after analgesic discontinuation?
True or false: MOH HAs are, by definition, never relieved by the usual amount of medications?
False--can provide short term relief.
What is the upper limit of using medications (days/month) in order to avoid MOH?
10 days / month
What is the treatment for MOHs?