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Flashcards in Headache Deck (84):
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subarachnoid hemmorhage

bleeding into the CSF fluid, usually due to leakage of an aneurysm or vascular malformation

1

migraine

syndrome characterized by intermittent pounding or throbbing headache, potentially preceded by an aura

frequent association with nausea, photophobia, phonophobia and exertional worsening

2

tension-type headache

recurrent headache with a bilateral squeezing and pressing senation that usually does not prevent normal activity and does not significantly worsen with exertion

3

cluster headache

recurrent, severe headache which is unilateral and periorbital and often asociated with autonomic symptoms of tearing and nasal congestion

4

temporal arteritis

condition of inflammation of major cranial blood vessels-->can result in blindness or stroke depending onvessels involved

5

paresthesia

abnormal sensation that is not due to an external stimulus

6

aura

warning, prior to onset of a symptom

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increased intracranial pressures do NOT

cause headaches

8

drainage of spinal hluid

causes low pressure headache secondary to fluid traction on venous sinuses when brain sinks towards tentorium as it loses CSF

9

inflammation in subarachnoid space

results in headache

10

lesions above tentorium produce

pain referred to trigem distributions (forehead, behind eyes) because dura in this region is supplied by trigem nerve

11

lesions in posterior fossa produce

pain ine ar, back of head (cn 9,10, and upper 3 cervical roots)

12

meningeal irritation headache

subarachnoid hemorrhage and meningitis

13

subarachnoid hemorrhage

sevre, sudden onset, persists, remainder of neuro exam normal

14

what do you do if you suspect subarachnoid hemorrhage?

do CT
if CT negative, do lumbar uncture

15

neoplasms

mild, nonspecific, worse in morning
focal symptoms

16

abscess

focal signs of mental changes often present
evidence of increased ICP
infection?

17

acute hydrocephalus

caused by obstructing CSF pathways (inflammation, blood, tumor)
brain dysfunction
fundi-->increased ICP

18

predisposing factors to intracranial hypertension

polycystic ovarian disease
high estrogen
exogengeous estrogen, vitamin a, outdated tetracycline

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what helps intracranial hypertension

carbonic anhydrase inhibitors
shunting

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protoypical patient for intracranial hypertension

overweight young woman

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three types of vascular headaches

giant cell (temporal) arteritis
hypertensive encephalopathy
vascular malformation

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giant cell temporal arteritis

systemic vasculitis
hypertensive encephalopathy
vascular malformation

23

giant cell temporal arteritis

systemic vasculitis that likes cranial nerves; usually in people over 50

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clinical picture giant cell arteritis

1- polymyalgia rheumatic- malaise, loss of energy, proximal jt pains
2- nonspecific headaches; associated with tenderness and swelling over temporal or occipital arteries
3- evidence of arterial insufficiency in distribution of branches of cranial vessels (jaw cluadication, infarction of tongue or scalp)

25

external carotid insuffiency

jaw claudication or infarction of the tongue or scalp

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internal carotid insuffiency

produces retina ischemia, blindness, even stroke

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sed rate giant cell arteritis

very high

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treatment giant cell arteritis

steroids

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ddx lupus

lupus inflames systemic

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to confirm after high sed rate

biopsy (bilaterally)

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hypertensive encephalopathy

cerebral vasoconstriction occurs in response to systemic HTN to preserve a constant cerebral blood flow-->autoregulation
--in this, autoreg fails at parts and arteries dilate despite severe HTN (-->edema and hemorrhage)

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hypertensive encephalopathy should be considered

patients with severe HTN, or preveiously normotensive patients that develop less evere HTN

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vascular malformations

may result in headaches with features of migraine

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venous sinus thrombosis

headache probably results from stretching of pain sensitive veins that drain into sinuses (although increased ICP may play a role)

35

main predisposing factors of venous sinus thrombosis

hypercoagulability and increased osmolarity
high estrogen states, dehydration

36

cervical headache

pain from cervical region--usually felt over neck and occiput-->can be refferred around temples and even into frontal region

37

two types of cervical headaches

occipital neuralgia-irritation or entrapment of grater occipital nerve
aterial dissection-result in acute neck pain sometimes acompanied by ischemic symptoms-

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metabolic headaches

often associated with hypoxemia, hypercapnia, anemia and possibly associated with cerebral vasodilation

39

glaucoma

pain localized in the eye or behind the head

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most significant criteria of dangerous headache

duration

41

migraine aura assocaited wtih

intracranial vasoconstriction

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BV dilation

does not directly cause pain; pain does appear to be from activation of nerves in BV that contribute to sterile inflame dilation

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spreading depression

most prominant theroy of causation: slowly spreading wave of initial neuronal excitation, followed by depression that spreads over cortex

44

scintillating scotomata

enlarging blind spot with shimering edge

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negative scotomata

blurring of visual field

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photophasia

colored blind spots

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fortification spectra

jagged lines

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symptoms in migraine often____, but can also be____

homonymous (cortical involvment)
visual loss in one eye due to retinal ischemia

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somatosensory march of migraine can be diffferentiated from sensory seizures by

-gradual onset
-slow march (several minutes between)
-NOT restricted to single BV as they are progressing on somatotrophic area
-usually clears first in area that was first involved

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general progression of aphasia in aura

visual
-->sensory
-->speech

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occulomotor, abducents nerve involvment in aura

less often, but may last for several weeks after onste at height of headache
mech--dilation of ICA compressed 3rd or 6th nerve in cavernosus sinus to cause paresis or paralysis

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familial hemiplegic migraines

onset early in childhod, strong family history common (genetics)

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Type 1 FHM

CACNA1A gene (P/Q channel)

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Type 2

Na-K ATPase

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Type 3

involves neuronal voltage gated Na channels

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in FHM..

headache appears first and symptoms of weakness and sensory loss appear later
--neuro signs freq outlast headache by hours or days and occasionally may be permanent

57

treatment of migraine

avoidance of trigger factors
medications during headache
preventative (prophylactic) medications

58

medications DURING headache

-nonspecific analgesics/anti-inflam
-meds that activate 5HT R (ergotamine derivatives and triptans)

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mechanism of ergotamine derivs and triptans

capable of affecting trigem nerve endings on BV-->decrease release of inflame neuropeptides (CGRP, Sub P) and constrict BV

60

two primary difficulties with short acting analgesics

becomes less effective when migraine is well established

frequent use of short acting meds results in gradual decrese in response to these meds (rebound headache)

61

preventative mds

betablockers
ca channel blockers
heterocyclic antidepressants
anticonvulsants

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pacing the floor

cluster headache

63

horners syndrome

cluster headaches

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gender and cluster headache

men more than women

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migrane chemicals

increase in level of blood 5HT at the onset of headaches and later a depletion

66

cluster headaches (differentially)

no change in 5HT levels, but have an increase in blood histamine concentration coincident with headache

overactivity in caudal hypothalamus during attack
breathing in O2 aborts quickly
no aura

67

tension type headache

when under pressure, mild cervical or bifrontal headache
hyperactivity of frontalis and cervical musculature

68

tension type headaches are more likely to be

chronic, and threfore more likely to result in frequent analgesic intake
analgesic rebound headache may be a problem

69

indomethacin responsive headache symptoms

group of headache symptoms that share characteristics of being highly responsive to indomethacin (as opposed to other NSAIDs)

70

IRHs fall into several categories

trigeminal-autonomic cephalgias (unilateral headache accompanied by a variety of autonomic symptoms in head)
headaches induced by valsalva
headaches taht have primary stabbing quality

71

trigeminal autonomic cephalgias

Short lasting
Unilateral
Neuralgiform headache
Conjunctival injfection
Tearing

-middle aged men; reocur but only last a few minutes

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trigem autonomic cephalgias vs paroxysmal hemicranias

similar but pain is longer and genreally in women

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indomethacin responsive headache symptoms

sharp and localized, short duration

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neuralgias

sharp, severe, brief
"trigger point"-areas of skin or mucosa that prvoke pain when touched
no sensory nerve included

75

Tic douloreaux

trigeminal neuralgia; usually occurs in elderly and involves second and tird trigem division
no sensory loss
treatment with carbamezapine- if dont treat you will need a procedure

76

glossopharyngeal neuralgia

less common; pain felt in throat, ear, neck
may be triggered by swallowing

77

definitive test for identifying aneurysm

angiogram

78

only way to rule out subarachnoid hemorrhage

lumbar puncture

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sudden onset headache with focal neurologic deficit

intracerebral hemorrhage

80

treatment of giant temporal arteritis can prevent

blindness
stroke

81

headache that awakens from sound sleep

increased intracranial pressure?
mass lesion, sagittal sinus thrombosis, pseudotumor cerebri

82

behavior or personality change

encephalitis, mass

83

migraine unilateral or bilateral

unilateral