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Flashcards in Headaches Deck (66)
1

What is the mnemonic for concerning symptoms with HAs?

-Systemic symptoms
-Neurological signs
-Onset sudden
-Old (more than 50)
-Prior h/o
-Secondary illnesses

2

New onset HAs in patient over how old is concerning for more severe disease?

50 years

3

What should the neuro exam always include with HA complaints?

Fundoscopy

4

What are the characteristics of the pain with HAs 2/2 a space occupying lesion in the brain?

Steady, non-throbbing HA that occurs in the morning or awakens patients

5

What usually worsens HAs 2/2 a space occupying lesion in the head?

Valsalva-disruption of CSF flow

6

What is the natural h/o space occupying HAs?

Slowly increases in frequency and duration

7

What is the leading cause of subarachnoid hemorrhage?

Rupture of cerebral arterial aneurysm

8

True or false: Regardless of the CT outcome, CSF fluids is needed if suspected subarachnoid hemorrhage

True--5% false negative rate

9

True or false: Giant cell arteritis, meningitis, and acute sinusitis can all cause a thunderclap HA

True

10

Which gender is usually more affected with reversible vasoconstrictive syndrome?

Females

11

What is the mean age of onset for reversible vasoconstrictive syndrome?

45

12

What are the characteristics of the HAs with reversible vasoconstrictive syndrome? How frequent are they?

Thunderclap HA that peaks within one minute, and is very intense. Followed by n/v.

Usually have multiple over a 1-4 week period

13

True or false: multiple "thunderclap" HAs over a week period is usually pathognomonic for reversible vasoconstrictive syndrome

True

14

What are the complications from reversible vasoconstrictive syndrome?

-Localized cortical SAH
-Ischemic/hemorrhagic stroke

15

What is the pathophysiology of reversible vasoconstrictive syndrome?

Transient disturbance of cerebral arterial vascular tone in segmental and multifocal fashion

16

What are the characteristics of the HA with meningitis?

Severe and global

17

What are the four major etiologies of low pressure HAs?

-Post LP
-CSF rhinorrhea
-Inappropriate shunt
-Primary intracranial hypotension

18

What is the characteristic features of low pressure HAs?

HA that is present when standing, but resolves upon lying down

19

What usually causes acute hydrocephalus?

Ventricular obstruction or shunt malfunction

20

What is pseudotumor cerebri?

Idiopathic intracranial HTN that often causes HAs

21

What is the sound that is heard with pseudotumor cerebri?

Pulsatile "swishing" tinnitus

22

What are the exam findings of pseudotumor cerebri (LP, fundoscopic)?

-High opening pressure with an LP
-Papilledema

23

What is the major sequelae of high pressure HAs?

Permanent visual loss

24

How do you diagnose high pressure HAs?

Normal imaging with appropriate history

25

What is the treatment for pseudotumor cerebri?

Weight loss and diuretics

26

What age does cranial arteritis occur?

50+

27

What are the labs that should be obtained if suspected cranial arteritis? (3)

ESR
CRP
Platelets

28

What are the associated s/sx of cranial arteritis? (3)

-Polymyalgia rheumatica
-Jaw claudication
-TTP over the temporal artery

29

What is the treatment for cranial arteritis?

Steroids treatment to prevent blindness

30

What is the cause of trigeminal neuralgia?

Crossing of a blood vessel over CN V frays the myelin sheath, and causes a "short circuit"

31

What systemic disease can cause bilateral trigeminal neuralgia?

MS

32

What are the drugs to treat trigeminal neuralgia? (2)

-Carbamazepine
-Lamotrigine

(antiepileptics)

33

What is the ultimate treatment for trigeminal neuralgia?

Gamma knife therapy or suboccipital craniotomy

34

What is CADASIL?

Cerebral AD arteriopathy with subcortical infarcts and leukoencephalopathy

35

What is the treatment for CADASIL? Prognosis?

ASA and usual HA treatment

Progresses to subcortical dementia

36

What are the symptoms like with CADASIL?

Recurrent HAs with neurological deficits and numerous TIAs beginning at a young age

37

How do you diagnose CADASIL?

CSF will show lymphocytosis, and MRI will show subcortical infarcts at a young age

38

What is HaNDL?

HA with neurological deficit and CSF lymphocytosis

39

What is the diagnostic imaging choice for secondary HAs?

MRI wwo contrast unless acute hemorrhage--then CT

40

What is the most common type of primary HAs?

Tension HA

41

What are the characteristics of tension HAs?

Non-pulsatile, pressing, squeezing pain that is without n/v or photo/phonophobia

42

How common are n/v and photophobia with tension HAs?

Rare

43

What is the treatment for tension HAs?

OTC analgesics

44

True or false: tension HAs are usually non-disabling

True

45

What is the diagnosis criteria for daily persistent HA?

Abrupt onset of less than 3 days of HA that does not remit

46

What is the treatment for persistent daily HA?

OCT analgesics
Gabapentin

47

What are the four major diagnostic criteria for migraines? Two minor? How many are needed?

Major:
-Unilateral
-Throbbing
-Worsened by movement
-Moderate or severe

Minor:
-n/v
-Photo/phonophobia

2 + 1 = migraine

48

Are migraines usually unilateral or bilateral?

Unilateral

49

Are migraines worsened by movement?

Usually

50

What percent of people have auras with migraines?

20%

51

What is the cause of the premonitory s/sx of migraine HAs?

Excess rush of dopamine

52

What is the postdrome s/sx of migraines?

Flu-like s/sx

53

What is the classic visual disturbance with migraines?

Scintillating scotoma

54

What is the cortical spreading depression theory of migraines?

-Wave of intense cortical neuron activity that is followed by neuronal suppression

55

What is the dysmodulated brain theory of migraines?

Activation of the dorsal pons leads to release of proinflammatory components, leading to meningeal blood vessel dilation, and subsequent CN V irritation

56

What are the 3 vasodilatory cytokines in migraines?

CGRP
NO
Substance P

57

What are the mast cell degranulation cytokines in migraines?

CGRP
Substance P

58

How long do migraines last?

4-72 hours

59

What is the most frequently reported trigger of migraines?

Stress

60

True or false: neck pain is uncommon with migraines

False--common

61

What usually causes primary intracranial hypotension HAs?

Nick in the dura from cervical problems (e.g. spondylosis etc), causes a slow loss of CSF

62

What are the MRI findings of primary intracranial hypotension?

Empty sella + meningeal enhancement + sagging into foramen magnum

63

What is the usual presentation of high pressure HAs?

-Transient visual loss (that becomes permanent)
-Papilledema
-Pulsatile tinnitus

64

True or false: patients with pseudotumor cerebri have normal imaging

True--have to have normal imaging

65

What is pseudobulbar palsy?

a medical condition characterised by the inability to control facial movements, as a result of damage of motor fibers traveling from the cerebral cortex to the lower brain stem

66

What are lacunar strokes?

a type of stroke that results from occlusion of one of the penetrating arteries that provides blood to the brain's deep structures