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Clin Med IV Exam II > Headaches > Flashcards

Headaches Flashcards

(67 cards)

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1
Q

Three primary headache syndromes

A
  • migraine
  • tension type headache
  • cluster headache
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2
Q

What should you ask a patient c/o a headache

A
  • quality
  • intensity
  • location
  • mode of onset
  • relationship to biologic events
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3
Q

Most important characteristic of “quality” of a headache

A

if it is pulsatile or not

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4
Q

Quality of a migrain

A

pulsating, throbbing, lateral

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5
Q

Quality of a tension headache

A

tightness and pressure, band like

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6
Q

Quality of neuritis

A

sharp, lancinating

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7
Q

Quality of cluster headache

A

ice pick

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8
Q

Quality of a headache d/t an intercranial lesion

A

dull or steady

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9
Q

Quality of a headache from opthalmologic disorder

A

peri-ocular pain

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10
Q

Quality of neuralgia

A

localized to a division of the trigeminal nerve

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11
Q

Headaches that wake a pt up from sleep

A

HA from meningitis, subarachniod, cluster HA

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12
Q

Where do migraines occur

A

on one side

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13
Q

HA d/t inflammation of an extracranial artery causes pain where

A

localized to the site of the vessel

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14
Q

Lesions of the paranasal sinuses, teeth, eyes, and upper CV cause pain where

A

across the forehead or maxilla or around the eyes

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15
Q

Intracranial lesions in the posterior fossa cause pain where

A

occipitonuchal region

unilateral if lesion is one sided

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16
Q

HA worse with wakening–>

A

sleep apnea or intracranial mass

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17
Q

HA at same time each day–>

A

cluster HA

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18
Q

What types of HA are worse at the end of the day

A

tension HA

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19
Q

HA that have an onset of seconds to minutes

A
  • subarachnoid

- thunderclap HA

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20
Q

HA that have an onset of minutes to hours

A
  • migraines
  • cluster
  • intracranial tumor
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21
Q

HA that have an onset of hours to days

A
  • migraines

- tension HA

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22
Q

Catamenial migraine

A

HA that occurs regularly in the premenstrual period

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23
Q

HA worse with sudden movement or by coughing or straining think—> ?

A

intracranial source

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24
Q

Allodynia

A

pain when the scalp is stroked in combing or fixing the hair

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25
What is a tension headache
tension or spasm withing the pain sensitive muscles of the neck or temples
26
What is not associated with a tension HA
- photophobia - phonophobia - nausea - vomiting
27
Tension HA gets worse with what
stress, noise, glare
28
What should be check in a pt over 60 presenting with a tension type headache
ESR look for Giant cell arteritis
29
What is not indicated for tension HA tx
Triptans
30
Treatment for tension HA
- similar to migraines - treat co-morbid anxiety and depression - behavioral therapy, relaxation training - massage
31
Migraine HA
episodic severe HA pain associated with nausea, photophobia and photophobia
32
Migraine HA may be associated with what
meningeal signs
33
PT's can experience what before a migraine
aura
34
Most important question to ask your pt if considering migraine
have you ever had a headache like this before?
35
People with migraines experience what types of things
positive phenomena Complex migraines--> speech or motor deficits
36
Criteria for migraine without aura
At least 5 attacks fulfilling following criteria: - last 4 to 72 hours - 2 of the following characteristics: unilateral, pulsating, moderate to severe intensity, aggravation by physical activity - at least one of the following: N/V, photophobia and phonophobia - no evidence of an underlying condition
37
Criteria for migraine with aura
At least two of attacks fulfilling the following - three of the following: one or more reversible aura sx, at least one aura sx developing gradually, no aura lasting longer than 60 minutes, HA following aura w/ a free interval of less than 60 minutes - no evidence of underlying disorder
38
What occurs with a basilar artery migraine
blindness or vision changes followed by paresthesias, disequilibrium, confusion states and occipital migraine
39
Opthalmoplegic migraine
lateralized pain in the eye accompanied by N/V, diplopia
40
Tx of migraines
- avoid precipitating factors - prophylactic - symptomatic pharmacologic treatment
41
Tx during acute migraine attack
- rest in a dark quiet room - simple analgesic - ergotamines - compazine - reglan - butalbital containing analgesics
42
When should ergotamines be avoided
- pregnancy - CV disease - CYP3A4 inhibitors
43
Triptans are often given with what
naproxem
44
Triptans should be avoided in what
- pregnancy - hemiplegic or basilar artery migraine - uncontrolled HTN - RF for stroke - coronary or peripheral vascular disease
45
Triptans can cause what
nausea and vomiting
46
When is preventative therapy for migraines indicated
if migraines occur >2-3 times a month
47
Preventative migraine rx
- botulism toxin type A injected into muscles - triptans - acupuncture - neurostimulation techniques
48
Pain in a cluster HA
- deep - retroorbital - nonfluctuating - explosive in quality
49
Core feature of cluster HA
periodicity
50
Associated features of cluster HA
tearing, miosis, ptosis, rhinorrhea
51
Prophylactic agents for cluster HA
- lithium carbonate - verapamil - topiramate
52
Treated of acute cluster HA
Often ineffective - SC or intranasal triptans - high flow O2 - dihydroergotamine IM or IV - viscous lidocaine IN
53
Post traumatic headache
1 day to week after injury
54
Characteristic of post traumatic HA
dull ache, may be accompanied by N/V, scintillating scotomas
55
What casues HA with intracranial mass lesions
displacement of vascular structures and pain sensitive tissues
56
When should you urgently refer a pt with a HA
- thunderclap onset - increasing HA unresponsive to simple measures - hx of trauma, HTN, fever, visual changes - presence of neurologic signs and scalp tenderness
57
Pseudotumor cerebri
idiopathic intracranial HTN characterized by papilledema, increased ICP with normal CSF, normal or small sized ventricles seen on brain imagine
58
Pseudotumor cerebri affects who
obese women, peaks in 3rd decade
59
When is the diagnosis of pseudotumor cerebri made
- pt has sx of increased ICP - no localizing sx - nonspecific or normal imaging study - CSF pressures are elevated over 250 w/ otherwise normal findings
60
Treatment of pseudotumor cerebri
- repetitive LP - carbonic anhydrate inhibitors - thiazides - corticosteriod if visual complaints
61
Surgical tx for pseudotumor cerebri
- lumbar peritoneal shunting | - optic nerve sheath decompression
62
Post herpetic neuralgia has a high occurance in what population
- elderly - immunocompromised - pts with severe rash - when first division of trigeminal is affected
63
Postherpetic neuraliga is characterized by
constant, severe, stabbing or burning, dysesthetic pain
64
Most common affected nerve with postherpetic neuralgia
V1
65
Testing of the painful area with postherpetic neuralgia will show what
decreased cutaneous sensitivity to pinprick
66
Tx of post herpetic neuralgia
- anticonvulsants - gabapentin - antispasmodic agents - botox - surgery - brain stereotactic radiosurgery - glycerol injection - balloon compression
67
Major complication of herpes zoster in the trigeminal distribution
impaired blink reflex--> corneal abrasion, scarring and vision loss

Clin Med IV Exam II (8 decks)

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