Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Emergency Medicine > Headaches > Flashcards

Headaches Flashcards

(84 cards)

Start Studying
1
Q

What age is concerning for HA?

A

<5 always a red flag
>50 w/ new HA, different, or worsening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What MOI is worrying for HA?

A

trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What onset is worrying for HA?

A

Sudden onset in SECONDS not minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is worrying for sudden onset of HA without exertion? With exertion?

A

Without = cerebral aneurysm (d/t
With = arterial dissection of the carotid or vertebrobasilar circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

If you have sudden pain with valsalva, what are you worried about?

A

Mass or lesion in the head d/t more pressure put on it.

Not worried if paired with sinus pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When is fever worrying? What do you ask about this?

A

If not paired with FLS
Ask if the HA or fever came first
Ask about ill contacts
Ask about CO poisoning
Toxin poisoning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What med history to you ask for HA?

A

What they use for their HA
If they use too much > 10 times = risk of rebound HA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does corticosteroids concerning for?

A

Higher risk of infection and being in an immunocompromised state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What can antibiotic use d/t your clinical presentation for HA?

A

Less severe s/s that may mask a more concerning condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does substance use do for HA?

A

Vasoconstriction leads to not having enough O2 to the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why ask alcohol use for HA?

A

Falls risk for acute
Increased risk of bleeding d/t damaged liver not producing coag factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

If a patient has a fever + HA, what should you ask?

A

Infectious ideology
HA + fever + neck stiffness + AMS = high likelihood of meningitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What do you look at for the eyes for HA?

A

Optic disk: papilledema = increased ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Even if a patient has a normal HA, what do you do?

A

Neuro exam DOCUMENT THIS and do baseline deficits vs new deficits

Altered mental status
CN exam
Motor - extremity weakness, pronator drift
Deep Tendon Reflex - assess asymmetry or a Babinski
Gait
Coordination testing (finger to nose, heal to shin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When do you order CBC and blood cultures for HA

A

suspected infectious etiology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

when do you get a COAG panel?

A

sus of a bleed or need for LP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

when do you get ESR/CRP

A

suspected temporal arteritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When do you get a a non-contrast CT scan for HA?

A

Abnormal neurologic examination to include altered mental status, cognitive impairment, or a focal deficit
New, severe headache of sudden onset
HIV-positive patients with presentation of a new headache
Concern for increased ICP in a patient requiring an LP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

when are you Concerned for increased ICP in a patient requiring an LP?

A

Immunocompromised patient, Hx of CNS disease (mass lesion, stroke or focal infection), new onset of seizures (within one week of presentation), papilledema, altered LOC, focal neurologic deficits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

when do you get a LP for HA?

A

meningitis, encephalitis, intracranial hypotension, pseudotumor cerebri, subarachnoid hemorrhage (if CT is negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Characteristics of migraines

A

slow onset, lasting up to 72 hours
+/- preceding aura
MC auras are lightheadedness and visual changes (scotoma¹ and scintillations²)
Unilateral HA - throbbing, pulsatile in nature
Worse with physical activity
Associated with N/V, photophobia, phonophobia
Patients prefer to lie still in a quiet and dark room
Neuro exam is normal (except photophobia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

1st line therapy for migraine in ER

A

ketorolac (Toradol) 30 mg IV or 60 mg IM (kids 0.5 mg/kg)
prochlorperazine (Compazine) 10 mg IV (kids 0.15 mg/kg)
diphenhydramine (Benadryl) 25 to 50 milligrams IV (kids 1 mg/kg)

in that order

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why do you use benadryl with compazine

A

comedication prevents uncontrollable movements seen in compazine

best way is to take compazine with saline to avoid uncontrollable movements.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

if a patient has recurrent HA w/in 3 days for migraine what should you do?

A

Add corticosteroid (dexamethasone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
If the 1st line therapy does not work for migraine, what can you do?
Triptans Ergots NOT for preggos d/t vasoconstrion
26
What meds can be used for preggo
acetaminophen, opioids, metoclopramide and corticosteroid are safe NSAIDs safe in 1st and 2nd trimester
27
what do you do for disposition of a patient w/ migraine?
sumatriptan or midrin
28
what is a cluster HA?
Unilateral, excruciating pain causing patient to “pace” or “rock back and forth” orbital, supraorbital, or temporal pain Pain lasts 12-180 minutes without treatment Associated ipsilateral symptoms lacrimation, conjunctival injection, nasal congestion/rhinorrhea, ptosis and/or miosis, edema of the eyelid/face, sweating of the forehead/face Recurring attacks daily for > week and remitting for at least 4 weeks a circadian/circannual pattern is noticed over a period of time average time between attacks 6 months to 2 years Attacks can be precipitated by ETOH or vasodilators Neuro exam is normal
29
1st line treatment of cluster HA
High flow O2 ¹ (HFO2) x 15 minutes 100% oxygen administered at 12 L/min through a nonrebreathing face mask
30
2nd line treatment of cluster HA
Sumatriptan if unresolved O2
31
3rd line treatment of cluster HA
Intranasal lidocaine ergotamine/caffeine IV dihydroergotamine (DHE 45)
32
discharge of cluster HA
corticosteroids (prednisone 60–80 mg/d tapered over 2 weeks) naratriptan (Amerge) 2.5 mg twice daily ergotamine 2 mg at bedtime or twice daily
33
tension HA characteristic
gradual bandlike stressor normal PE
34
treatment of tension HA
same treatment as migraine! NSAID’s or non-opiate analgesic +/- caffeine +/- antiemetic/sedative ketorolac¹ + Compazine/Reglan² + diphenhydramine³ IV for acute relief in ED¹
35
when should you take meds for HA
as soon as you feel it
36
SE of muscle relaxant
sedation take it at night
37
what is the presentation of a brain tumor
varity of stages early = mild HA as it progresses, HA worsens Deep, aching pain migraine or tension-like no deficits early on but later pain worse when they first wake up or with bearing down (biggest factor) n/v, seizures, mental status change
38
what do you order if you are worried about brain tumor
CT w/ IV contrast MRI is not easily accessible
39
Before you get CT with IV contrast, what do you need?
requires a chemistry panel BUN/Cr
40
When do you do Emergent neurological/neurosurgical consultation of brain tumor
large, symptomatic tumors signs of increased ICP impending herniation
41
What treatment do you do for brain tumor in ER
IV glucocorticoids to reduce cerebral edema Dexamethasone Secondary prevention with antiseizure agent levetiracetam (Keppra), topiramate (Topamax), lamotrigine (Lamictal), valproic acid, and lacosamide (Vimpat) Secure airway if signs of impending herniation on imaging
42
What is post-traumatic HA syndrome?
History of trauma Non-specific HA Fatigue/dizziness/vertigo first THEN mental health changes, sensitivity of noise
43
If a patient comes in with a post-traumatic HA three days after the incident, what do you do?
Order imaging CT w/out contrast
44
If a patient comes in with a post-traumatic HA three days after the incident and they already had imaging, what do you do?
Do not need imaging, just give reassurance.
45
Patient education for post-traumatic HA
Avoid 2ndary injuries (anything that can lead to a 2nd brain injury, which can lead to permanent damages) Can take weeks to recover Avoid activities that worsens symptoms Gradually increase activity in ER, you will just tell them to f/o with PCP
46
when do you refer for post-traumatic HA?
ophthalmology if visual complaints ENT if vertigo is present neuropsych if prominent mental illness symptoms
47
MC symptom of Idiopathic Intracranial Hypertension aside from HA
visual changes
48
s/s of Idiopathic Intracranial Hypertension
Headache Transient visual obscurations² Intracranial noises (pulsatile tinnitus) Scotoma/scintillations Back pain Retrobulbar pain (pain behind the eye) Diplopia Sustained visual loss (will become permanent if treatment is delayed) Physical Exam papilledema, visual field loss, 6th CN (abducens) palsy (loss of lateral gaze) other CN may be affected but much less commonly
49
What is a grade 5 optic disk?
severe papiledema
50
what do you first get for Idiopathic Intracranial Hypertension
CT without contrast d/t so many symptoms. Normal. However, you are ruling it out
51
When CT w/out contrast comes back normal for a Idiopathic Intracranial Hypertension, what do you do?
Get a LP
52
When performing a LP for Idiopathic Intracranial Hypertension, what's important to remember?
ASSESS FOR OPENING PRESSURE remember, HTN Lateral decubitus with knees extended
53
what should you avoid during LP in order to avoid falsely elevated pressure
avoid valsalva (breath holding/crying) to avoid falsely elevated pressure
54
What is the opening pressure of Idiopathic Intracranial Hypertension typically?
> 25 cm H2O in adults > 28 cmH2O in children
55
What is CSF of Idiopathic Intracranial Hypertension
normal
56
Management of Idiopathic Intracranial Hypertension
removal of CSF during LP until target pressure of 10-20 cm H2O is reached
57
if a patient has an opening pressure of 28, how much do you need to remove?
at least 8 mL to get to 20 cm H2O Appx. 1 mL of CSF will lower pressure by 1 cm H2O serial monitoring but don't use a 2nd LP
58
if the patient has visual symptoms with Idiopathic Intracranial Hypertension, what do you give?
acetazolamide Add on a thiazide diuretic if worsening visual symptoms despite max acetazolamide
59
After being stable and getting to an opening pressure <20 H2O, what is the next step of management for a patient with a NEW dx of Idiopathic Intracranial Hypertension?
Admit for further workup
60
After being stable and getting to an opening pressure <20 H2O, what is the next step of management for a patient with RECURING dx of Idiopathic Intracranial Hypertension?
consult with neurosurgeon regarding disposition ensure a quick outpatient f/o
61
What is the MC history of Intracranial Hypotension
LP because CSF leaks, leading to HA
62
What is a key factor of Intracranial Hypotension HA?
Laying down helps and upright is worse (working against gravity) dizziness neck pain low back pain from LP vertigo
63
What do you avoid in work up Intracranial Hypotension
AVOID LP because opening pressure is < 6 H20 and this is what caused it in the first place diagnosis based on history
64
Although MRI/CT is not required in post-dural puncture / Intracranial Hypotension, what would it show and why?
diffuse enhancement of the meninges we can see because there is not a lot of CSF
65
Initial treatment of Intracranial Hypotension
symptomatic: lay flat IV fluids to build up CSF tylenol (non-opiate treatments)
66
If a patient does not have improvement w/in one week of Initial treatment of Intracranial Hypotension, what do you do?
Consult anesthesiology to determine the need for epidural blood patch to create a clot
67
What is the MOA of a brain abscess?
An inflammation of the brain that develops into a central pus-filled cavity surrounded by a layer of granulation tissue and an outer fibrous capsule
68
MC way to get a brain abscess
blood travel from teeth
69
MC findings of brain abscess
HA Focal neurologic deficits Fever also can see Seizure S/S of increased ICP papilledema, N/V, change in LOC, confusion
70
What is the workup for brain abscess?
CT or MRI brain - both with contrast is diagnostic CBC - elevated WBC CMP - assess end-organ function Inflammatory markers (CRP, ESR) elevated in ⅔ of patients Blood cultures x 2 - before first abx dose
71
what should you avoid in a brain abscess?
LP - because it could lead to herniation
72
treatment of brain abscess with odontogenic source
IV PCN G (alt. ceftriaxone PLUS metronidazole) neuro for aspiration typically
73
treatment of brain abscess with Post-neurologic source
vancomycin PLUS ceftazidime neuro for aspiration typically
74
treatment of brain abscess without tooth or brain source
Cefotaxime (alt. ceftriaxone) PLUS metronidazole 500 milligrams IV every 6 h neuro for aspiration typically
75
When do you use steroids for brain abscess
ONLY IF significant peri-abscess edema with associated mass effect (shift of brain structure to one side) and increased ICP want to decrease herniation
76
What does steroids due to an abscess?
It can break it down. so you gotta be careful
77
Spinal epidural abscess etiology
Hematogenous spread from soft tissue (S. aureus - MC), urine or respiratory source
78
RF of spinal epidural abscess
IV drug use Immunosuppression Spinal procedure
79
MC location of spinal epidural abscess
thoracic and lumbar
80
s/s of spinal epidural abscess
Back pain + fever (worried if these two) spinal tenderness to percussion
81
Cauda equina symptom progression can happen after spinal epidural abscess
Retention at first followed by incontence, motor weakness, and then paralysis (saddle anesthesia) over inner thighs
82
Diagnostic of spinal epidural abscess
MRI with contrast of the spine is preferred imaging Alt. CT with contrast is the alternative if MRI isn’t available CBC - leukocytosis (60-70% of patients) Elevated ESR/CRP Blood cultures
83
What is CI in spinal epidural abscess
LP
84
Management of spinal epidural abscess
Urgent consult neurosurgery¹ Empiric antibiotics Indications - unavoidable delay in surgery, signs of neurologic dysfunction or sepsis Regimen: vancomycin PLUS ceftazidime

Emergency Medicine (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions