Headache Flashcards
primary HA
- Migraine
- Tension
- Trigeminal Autonomic Cephalilgia
- Cluster
- Paroxysmal Hemicrania
- Short-lasting unilateral neuralgiform (SUNA )
- Hemicrania Continua
Secondary
- Turmoer
- Bleed
- Increase ICP
- Injury
- Other medications
Primary
Migraine
- **Unilateral **
- Trobbing/Pulsatile
- Photophobia
- N/V
- 2 to 72 hrs
- PIN acronym ( Pulsation ; Intensity Nausea )
Primary
Tension Type of HA
Bilateral
Mild to moderate
Non throbing
30 mitns to 7 days
Cluster
- Uniateral
- Orbinal /Tempral
- Severe Attack
- last 15 mints to 180 mintutes
- Ipsilateral autonimic symtoms ( refer to symptoms that occur on the same side of the body as a particular neurological condition or lesion.
- Periorbital edema , orbital edema
Secondary HA Assessment
- Rule out serious underlying pathology and differentials
- Throught H and P: OLDCARS
- Red Flags : **SNNOOP 10 **
SNNOOP 10
- Systmeic Symptoms
- Neoplasm
- Neurologix deficit
- Onset sudden or abrupt
- Onset >50 yrs
- Pattern change of new HA
- POstion of hA
- Precipita sneey
- Pregnancy
- Painful eyy
- Post trauma
- HIV
- Pain med over use
Thunderclap Headache
***** Severe and Sudden Onset
* Last seconds to only a mint
* May have N/V/F or Seizures
**Plan: **
Urgen Evaluation to R/O :
SAH
HTN Crisis
Secondary HA
Dx
**Emergency settings : **
* CT w/ contrast
* CT W/O contrast
* Lumbar Puncture
**Non-emergenent settings
*** MRI of brain w constrast
Secondary HA :
**Lumbar Puncture **
**Indication of LP : **
* Clinical supicion of SAH **w/negative head CT **
* Evaluation CSG for RBCs
* Infectioous
* Inflamation
* Neoplastic
Urgent LP
* ****Suspect infectio or SAH
* **Non-Emergent”
**Carcinom, NS, GBS, vasulitis
***
***CSG: C ( canser) S ( SAH ) F (fever/infection ) **
LP contraindication
- Infection to skin
- brain abcess
- midline shift
- increase ICP
- Anticoagulation
LP complication
Herniation : most serious
Post LP HA
Migrain TX
Triptans + NSAIDS
Antiematics
TX Tension HA
NSAID
Caffeine+ Tylenol +ASA
Firocet not recommended as 1st line tx
Cluster Tx
Oxygen ( NRM 10L upper position )
Triptans
Verapamil ( Chronic ha )
Secondary HA TX
Dx the problem and treat underlying contidion
Hepiphlegic Migraine
Clinical Findings
**Hallmark sign **
* Unilateral weakness after a migrain e
* Imparied vision, speech, sensation
**Motor Auras
* ** Two or more experineced visual, sensory, aphasia)
* Envolves over 20 mints with hours to resoved
Heat CT or MRI
Hemiplegic Migraine
DX
- Reversible aura
- Aura spreads gradually, gradually, two or more occure in succession
- At least one aura is unileteral
- Accompanied by HA
- At least two attacks as above
Mecications to Avoid
Triptans
Beta Blockers
Bell’s Palsy
- Facial Nerve Palsy : CN VIII
- **Most Common Cause: **
- Viral
- Herpes Simplex
CN VIII
Facial
Bell’s Palsy S/S
General neuro exam
Facial movement
External ear with any scabbin or vesicle(herpers)
Parotid mass
Sparing of the forehead ( central etiology): condition or symptom affects most of the face except the forehead.
Bells Palsy Imaging and Dx
EMG
CT scan
Blood studies: R/O sytemic diseases
Bells Palsy TX
Glucotricoid
* Prednisone 60 mg to 80 mg /day for 1 wk
* Artificial tears
* Patch HS
