Headache Flashcards
1
Q
Most common cause of Primary headache
A
Tension type 69%
2
Q
Most common cause of secondary headache
A
Systemic infection 63%
3
Q
Percentage of tension headache
A
69%
4
Q
Percentage of headache secondary to systemic infection
A
63%
5
Q
Percentage of headache secondary to migraine
A
16%
6
Q
Percentage of headache secondary to IDIOPATHIC STABBING
A
2%
7
Q
Percentage of headache secondary to CLUSTER HEADACHE
A
0.1%
8
Q
Percentage of headache secondary to EXERTIONAL HEADACHE
A
1%
9
Q
Percentage of headache secondary to HEAD INJURY
A
4%
10
Q
Percentage of headache secondary to SUBARACHNOID HEMORRRHAGE
A
Less than 1%
11
Q
Percentage of headache secondary to BRAIN TUMOR
A
0.1%
12
Q
PRIMARY HEADACHES
A
- Tension type
- Migraine
- idiopathic stabbing
- EXERTIONAL headache
- Cluster headache
13
Q
Secondary headaches
A
- Systemic infection
- Head injury
- vascular disorders
- SAH
- BRAIN TUMOR
14
Q
Primary headaches
A
Headache and its associated features are the disorder in itself
15
Q
Secondary headache
A
Headaches caused by exogenous disorder
16
Q
Cranial structures that produce pain
A
- SCALP
- Middle meningeal artery
- Dural sinuses
- Falx cerebri
- Proximal segments of the large pial arteries
17
Q
The key structures involved in primary headache
A
Download
18
Q
Headache symptoms suggesting serious underlying disorder
A
- Sudden onset headache
- First severe headache
- WORST HEADACHE EVER
- vomiting that precedes headache
- Subacute WORSENING over days or weeks
- pain induced by Bending, Lifting and cough
- Pain that DISTURBS SLEEP or present immediately upon awakening
- Known systemic illness
- Onset after AGE 55
- Fever or unexplained systemic signs
- Abnormal neurological exam
- Pain associated with local tenderness (region of temporal area)
19
Q
When a primary health care physician feels the diagnosis I’d primary headache, it is worth noting that more than ___ % of patients will have “MIGRAINE”
A
90%
20
Q
Acute severe headache with STIFFNECK AND FEVER
A
Meningitis
21
Q
LUMBAR PUNCTURE IS MANDATORY
A
Meningitis
22
Q
There is striking accentuation of pain with EYE MOVEMENT
A
Meningitis
23
Q
Easily mistaken for MIGRAINE
Cardinal symptoms of POUNDING HEADACHE, PHOTOPHOBIA , nausea and vomiting are present
A
Meningitis
24
Q
Acute severe headache with STIFFNECK AND “without” FEVER
A
Subarachnoid hemorrhage
25
May present with headache alone
ruptured aneurysm, arteriovenous malformation and intraparenchymal hemorrhage
26
If the HEMORRRHAGE is small or below the foremen magnum
CT SCAN can be normal
27
True or false:
Lumbar puncture may be required to definitely diagnose subarachnoid hemorrhage
True
28
___% of patients with brain tumor considers headache as chief complain
30%
29
The pain is usually nondescript, intermittent deep dull aching of moderate intensity
Headache secondary to Brain tumor
30
Headache which worsen by exertion or change in position and may be associated with nausea and vomiting
BRAIN TUMOR
31
Th headache of brain tumor disturbs sleep in ____%
10%
32
Brain tumor with Vomiting that precedes the appearance of headache by weeks
Posterior fossa brain tumors
33
Brain tumor with history of amenorrhea or galactorrhea
Prolactin secreting pituitary adenoma or PCOS
34
Headache arising de novo in a patient with known malignancy suggest
1. Cerebral metastases
2. CARCINOMATOUS MENINGITIS
Or both
35
Headache appearing abruptly after bending, lifting, or coughing can be due to
1. Posterior fossa mass
2. Chiari malformation
3. Low cerebrospinal fluid CSF volume
36
Annual incidence of TEMPORAL ARTERITIS
77 per 100,000 individuals age 50 and older
37
TEMPORAL ARTERITIS average age of onset
70 years old
38
TEMPORAL ARTERITIS ___% of women prevalence
65%
39
Untreated TEMPORAL ARTERITIS develops blindness due to involvement of ophthalmic "artery" and its branches
About half of patients
40
Effective in preventing complications if TEMPORAL ARTERITIS
GLUCOCORTICOIDS
41
Ischemic optic neuropathy induced by giant cell arteritis is the major cause of rapidly developing bilateral blindness in patients age?
>60 years old
42
Initial management of TEMPORAL ARTERITIS / giant cell arteritis
Temporal artery biopsy followed by immediate treatment with PREDNISONE 80mg daily for the 1st 4-6 weeks
43
Headache often starts with severe eye pain often red with a fixed moderately dilated pupil
GLAUCOMA
44
Broad diagnosis of chronic daily headache
Headache 15 days or more per month
45
___% of population based estimate of adults having daily or near daily headache
4%
46
Positional headache- begins when the patient sits or stands upright and resolves upon reclining
Low CSF volume HEADACHE
47
Usually occipito-frontal which may not begin at waking hours but worsens during the day
Low CSF volume headache
48
Incidence of POST-LUMNAR PUNCTURE headache
10-30%
49
Most common cause of low CSF volume headache
CSF leak following LP
50
Usually begins 48hours but maybe delayed up to 12 days
Post LP headache
51
May provide temporary relief on low CSF volume headache
Beverages with CAFFEINE
52
Index events lowers CSF volume or CSF leaks
1. Epidural injection
2. Valsalva maneuver
3. Lifting, straining and coughing
4. Clearing the Eustachian tube in the AirPlain
5. Multiple orgasms
53
Low CSF pressure
Typically: 0-50 mm h20
| As high as: 140 mm h20
54
Initial study of choice for CSF LEAK (low CSF volume headache)
MRI with GADOLINIUM
55
CSF leak striking pattern in MRI
DIFFUSE MENINGEAL ENHANCEMENT
56
Initial treatment CSF leak or low CSF volume
BED REST
57
Treatment for patients with persistent low CSF volume
IV CAFFEINE - 500mg in 500ml of saline administered over 2 hours
* ECG DONE first to screen for arrhythmia before administration of IV caffeine
* at least 2 infusions before doing additional tests
58
If IV caffeine fails
1. Abdominal binder -> AUTOLOGOUS BLOOD PATCH is curative
| 2. Oral theophylline - for px with intractable pain
59
* History of general Headache
* WORST with RECUMBENCY
* present upon waking and IMPROVES as day goes on
* Straight forward if with PAPILLEDEMA
* Visual obscurations are frequent
RAISED CSF PRESSURE HEADACHE
60
Initial study of px with RAISED CSF PRESSURE
MRI including MR VENOGRAM
61
Diagnostic of raised CSF PRESSURE headache
improvement of headache following removal of 20-30ml of CSF
62
Initial treatment of raised CSF pressure
ACETAZOLAMIDE 250-500mg BID
63
Next treatment of choice with raised CSF pressure headache
TOPIRAMATE
64
TOPIRAMATE MOA
1. Carbonic anhydrase inhibition
2. Weight loss
3. Neuronal membrane stabilization (mediated by phosphorylation pathways)
65
Chronic subdural hematoma may mimic this headache
POSTRAUMATIC HEADACHE
66
Post traumatic headache treatment
Tricyclics antidepressants : AMITRIPTYLINE
ANTICONVULSANTS: TOPIRAMATE, valproate and gabapentin
MOA INHIBITOR "PHENELZINE"
67
Post traumatic headache upon treatment resolves within
3-5 years
68
The innervation of the large intracranial vessels and dura matter by the trigeminal nerve
Trigeminovascular system
69
Typically presents with headache, polymyalgia rheumatica, jaw claudication, fever and weight loss
*SCALP TENDERNESS
Temporal arteritis
70
* Worst at night and aggravated by exposure to cold
| * reddened, tender nodules or red streaking of the skin overlying temporal arteries or less commonly occipital arteries
Temporal arteritis/ giant cell
71
Chronic daily headache preventive measures
Tricyclics doses up to 1mg/kg with starting dose of 10-25mg daily given 12 hours before the expected time of awakening to avoid excess morning sleepiness
1. AMITRIPTYLINE
2. Nortrtyline
3. Anticonvulsant: TOPIRAMATE, valproate and flunarizine
72
Outpatient approach to manage medication overuse
Reduce medication dose by 10% every 1-2 weeks
73
Help relieve residual pain as analgesic is reduced in outpatient
NAPROXEN 500mg BID
74
Disease that complicated withdrawal in outpatients
DM
75
Drug used for OPIOD Withdrawal symptoms in inpatients
CLONIDINE
76
Useful For acute intolerable pain during waking hours in management of medication overuse in inpatients
ASPIRIN 1 g IV
77
Useful at night for the management of medication overuse in inpatients
IM CHLORPROMAZINE
78
How many days into admission does the effect of withdrawn substance wears off
3-5 days
79
After the effect of withdrawn substance wears off, what drugs can be used to induce significant remission
IV DHE Dihydroergotamine every 8 hours for 5 consecutive days
80
Drugs required with DHE to prevent significant nausea
1. 5-HT3 antagonist : ondansetron, granisetron, neurokinin receptor antagonist
2. DOMPERIDONE
81
upper limit Evolution of new daily persistent headache
3 days
82
Most serious form of the secondary headache
Subarachnoid hemorrhage
83
TCA Antidepressants that Are useful for the management of chronic pain
TCA's particularly NORTRIPTYLINE
| DESIPRAMINE
84
Painful conditions that respond to TCA
```
Postherpetic neuralgia
Diabetic neuropathy
Tension headache
Migraine headache
Rheumatoid arthritis
Chronic low back pain
Cancer
Central post stroke pain
```
85
Non-tricyclics antidepressants block both NE and serotonin reuptake
VENLAFAXINE (Effexor)
| Duloxetine (Cymbalta)
86
Use primarily for neuropathic pain (trigeminal neuralgia)
Anticonvulsants and anti-arrhythmics:
Phenytoin (dilantin)
and carbamazepine (tegretol)
87
Newer Anticonvulsants used for broad ranged neuropathic pains
Gabapentin (neurontin)
| Pregabalin (lyrica)
88
Orally administered chronic OPIOD medication Used for long term outpatient
Levorphanol, methadone, sustained release morphine and transdermal fentanyl
89
Provide immediate relief for postherpetic neuralgia with cutaneous hypersensitivity
Lidocaine patches /lidoderm
90
First line drug for neuropathic pain
Antidepressants:
NORTRIPTYLINE
DESIPRAMINE
Snri:
Duloxetine
VENLAFAXINE
91
First line In elderly patients with neuropathic pain who require high level mental activity
VD
| VENLAFAXINE AND DULOXETINE
92
On average, standard doses of mostantihypertensive agents reduce blood pressure by
8–10/4–7 mmHg
93
True or false:
Younger patients may be more responsive to beta blockers and ACEIs, whereas patients aged >50 years may be more responsive to diuretics and calcium antagonists.
True
