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Flashcards in HA 2 Deck (64)
1

What is needed to diagnose a sinus HA?

Acute sinusitis:
-Purulent nasal d/c
-Pathological sinus findings on imaging

2

True or false: chronic sinusitis is a cause of sinus HA

False--does not count for diagnosis unless progresses into an acute episode

3

Activation of the TNC results in what?

Activation of cranial PNS nerves extending into the sinus cavities and tear ducts

4

True or false: sinus pressure and symptoms are not usually associated with migraines

False

5

What is the most common HA that is seen by the neurologist?

Migraines

6

What is the acute treatment for migraines?

-NSAIDs
-Triptans
-Dihydroergotamine (DHE)

7

What is the rescue therapy for migraines HAs?

Steroids PO

8

What is the MOA of triptans?

5HT agonists to selectively constrict the meningeal arteries by blocking the release of vasoactive peptides

9

What are the FDA approved drugs for migraine prevention? (3)

-Topiramate
-Timolol
-Propranolol

10

What is the use of botulinum toxin in treating migraines?

Prophylactically for chronic migraine suffers

11

What is the "indication" for butterbur? Side effects?

-Migraines
-Liver toxicity

12

What are the supplements for migraine prophylaxis?

-Mg supplementation
-High dose B2

13

True or false: gabapentin is only used for acute attacks of migraines

False--prophylactically

14

What is the diuretic that may help with migraine prophylaxis?

Candesartan

15

What type of antidepressants are used for migraines?

TCAs

16

What are the three major TCAs?

-Amitriptyline
-Nortriptyline
-Imipramine

17

The use of abortive treatments for migraines should be limited to how many times per week? Why?

2
Avoid the development of rebound HAs

18

What may happen with numerous, untreated migraines?

Increase in frequency, duration, and severity d/t changes in pain generators

19

How long does it take for migraine prophylaxis to be effective?

8-12 weeks

20

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

21

What are the characteristics of cluster HAs?

Piercing, unilateral stabbing pain, accompanied by ipsilateral lacrimation and nasal congestion

22

Which gender is usually affected with cluster HAs?

Males

23

How often do cluster HAs recur? When in the day do they usually occur?

1-10 attacks per day, usually at night

24

How long do episodes of cluster HAs happen?

30-120 minutes

25

What is the seasonal pattern of cluster HAs?

usually in the fall and spring

26

What is the prophylactic treatment for cluster HAs?

-Verapamil
-Topiramate
-Li

27

What is the bridge therapy for cluster HAs for the prophylactic meds to kick in?

Starting dose of oral steroids

28

What is paroxysmal hemicrania?

Cluster HAs that usually occur a ton per day--up to 40 times/day

29

What is the diagnostic criteria for paroxysmal hemicrania?

HA has to abort with indomethacin use

30

What is SUNCT?

Short-lasting unilateral neuralgiform HA with conjunctival injection and tearing

31

What are the s/sx of SUNCT?

Similar to trigeminal neuralgia, but with ipsilateral ANS s/sx

32

What is hemicrania continua? Treatment?

-HA that is constant 100% of the time, with associated ipsilateral ANS s/sx
-Indomethacin

33

What is a chiari malformation?

Posterior fossa contents that slip through the foramen magnum--congenital malformation

34

What percent of HA in HA clinics are d/t medication overuse?

80%

35

What is the most important risk factor for chronic daily HA?

Medication overuse

36

What are the characteristics of analgesic overuse HAs? (Bilateral or unilateral? Character? Intensity?)

-bilateral
-Pressing/tightening
-Mild-moderate intensity

37

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

38

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

39

What is the pathophysiology of MOH HAs?

Continued use of analgesics upregulates 5HT receptors, leading to a lower threshold for HA development

40

What is the frequency of MOHs?

Daily or nearly daily

41

What are the accompanying s/sx of MOH HAs?

-GI disturbances
-Anxiety/irritability

42

What type of HA usually causes med overuse?

Migraines

43

Why is it necessary to choose the most efficacious med for HAs?

Use of suboptimal medications leads to increased usage

44

What were the results of the head-HUNT study, in terms of the increased risk for migraines and non-migraines with medication overuse?

Overuse causes:
-Relative risk of chronic migraine elevated by 13.3 times
-risk of chronic non-migraine HA elevated 6.2 times

45

True or false: when migraines patients with a non-headache medical condition take analgesics daily for that condition, they can develop MOH

True

46

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

47

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

48

What is the role of the trigeminal nucleus caudalis?

Pain input nucleus in the trigeminal pathway

49

What is the role of the mesencephalic nucleus of the trigeminal nerve?

Proprioception of the face

50

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

51

What are the contraindications for triptans?

Smokers
MI
Strokes

Anything where you want to avoid constriction of arteries

52

What is the definition of migraines? Treatment?

15 or more migraines / month for more than 3 months

Quarterly botox injections

53

What is the most common manifestation of TACs?

Cluster HAs

54

What is the acute therapy for cluster HAs? (3)

-Oxygen
-DHE
-Triptans

55

What is the primary prophylactic therapy for cluster HAs? What should always be checked, prior to administering this?

Verapamil

EKG should be obtained

56

What is the diagnostic criteria for hemicrania continua?

Must resolve with indomethacin administration

57

For the diagnostic criteria of AOH, a HA has to be present for how many days /month?

15 days

58

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

59

For the diagnostic criteria of AOH, what has to happen to the severity of the HA with analgesic use?

Increased intensity

60

For the diagnostic criteria of AOH, the HA has to resolve within what timeframe after analgesic discontinuation?

2 months

61

True or false: MOH HAs are, by definition, never relieved by the usual amount of medications?

False--can provide short term relief.

62

What is the upper limit of using medications (days/month) in order to avoid MOH?

10 days / month

63

What is the treatment for MOHs?

Detox

64

Inability to look up = ?

Midbrain issue