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Flashcards in Headache Deck (23):

IIH workup

see pt with hx of HA, dull pain, no auras, or trigger. sneeze- lose vision for a few sec, papilledema= suspect
get LP to record IC OP= temporaly relief sx. can be due to excess Vit A



carbonic anhydrase inhibitor. decr CSF production in IIH pt.


temporal arthritis

arteritis of extra cranial carotid artery and its branches. commonly present in pt >60 with an indolent HA in temple or jam claudication, associated with polymyalgia rheumatic. pain is constant, worse with chewing. path- giant cell in blood vessel
tx: prednisone
most feared complication if no tx is unilateral visual loss


temporal arteritis dx

elevated ESR, CRP, biopsy of temporal artery. may be skip lesions so biopsy multiple areas.


cluster HA tx

tx: 100% O2 10min. prophylactic- Ca ch blocker-verapamil, steroids, lithium


cluster HA dx

A at least 5 attacks of severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180min untreated + 1 or more of the following IL as pain: conjunctival injection, lacrimation, nasal congestion, rhinorrhoea, forehead and facial sweating, mitosis, ptosis, eyelid edema,
B: freq of attacks from every other day to 8/d


migraine dx criteria

A) >5HA 4-72hr +2/4 sx: unilateral, pulsating, impair func, aggravated by routine physical activity
B: during Ha 1/2: phono/photophobia, N/V
C: >1 aura: homonymous viaul disturbance, unilateral paresthesias and or numbness, unilateral weakness, aphasia or unclassifiable speech difficulty


basilar migrane

sx referable to basiar A- visual disturbances, vertigo, confusion, brainstem dysfunc


familial hemiplegic migraine

auto dom migraine variant manifest by hemiparesis during migraine aura. accompanied by other sx- ataxia or changes in consciousness


ophthalmoplegic migraine

retroorbital pian and CN palsies- CN3/4/6



abortive tx for migrane. ex sumatriptan
CI- CAD bc triptan meds have vasoconstrictive properties, and in pt with hemiplegic migraine bc concerned about stroke


migraine prophylaxis

I: >2/mo+ disturbe lifestile
antiepileptic, tricyclic antidepressants, ca blocker, beta blocker. topiramate=most common, amitriptiline, depakote, propranolol, riboflavin


CNS neoplasm v HA

red flags- HA in an older person wo hx HA. HA associated with focal near deficit or personality changes. HA in an IC pt. HA worse in morning. associated with signs of systemic disease- fever, wt loss



tumor that arise from goal cells- astrocyte, oligodendrocyte, ependymal cells, cells of choroid plexus. 1/2 of primary brain tumor



2/3 are glioblastomas.


WHO grades

I: juvenile pilocystic astrocytom, giant cell astrocytoma (associated with tuberous sclerosis), pleomorphic xanthroastrocytoma. cure with complete resection. most in children
II: diffuse or fibrillary astrocytoma, oligodendroglioma: 7-8y
III: anaplastic astrocytoma, anaplastic oliodendroglioma: 2-3y
IV- glioblastoma 9-12mo
single tumor may have dif grade at dif sites. mitotic activity correlate with prognosis


CNS tumor sx

4 types
1) progressive, focal neuro deficit- weakness, visual loss, aphasia
2) HA worse in recumbency, associated with N/V, other sx of ICP
3) seizure if irritate cerebral cortex
4) gradual slowing and personality changes
sx dep on location of tumor and rate of growth



most common tumor of childhood. in cerebellum. present with ataxia+ sign of IPC (HA, vomiting). type of PNET


grade IC astrocytoma tx

evacuate mass +radiotherapy


tension HA

A: 30min-7d
B: at least 2: pressing/tightening (nonpulsatile), mild or moderate-inhibit but not prohibit, bilateral location, no aggravation by routine physical activity
C: both: no N/V, 1 or neither photo/phonophobia


intracranial hypotension

HA improve when lay down. tx: autologous blood patch


intraventricular tumor

cause sx by block CSF. cause positional HA and loss of consciousness due to sudden incr in ICP if acutely obstruct. ex colloid cyst, meningioma, central neurocytoma


closed angle glaucoma

30mmHg, N/V,. pupil dilated and fixed. oval pupil sometimes. emergency- need timolol drops