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Flashcards in Headaches Deck (62)
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1

What nerve pain receptors are activated in migraine HA's?

Trigeminal nerve

2

List the 5 main migraine triggers

1. Emotional stress
2. Hormones in women (estrogen): menstruation, menopause, pregnancy
3. Diet: missing a meal
4. Weather
5. Sleep disturbances

3

Define osmophobia

Sensitivity to smells/odor
Migraine sx

4

Define cutaneous allodynia

Sensitivity to touch
Migraine sx

5

What type of migraine is a Migraine without aura?

Common= 75%

6

What type of migraine is a Migraine with aura?

Classic= 25%

7

Chronic migraine classification

> or equal to 8 days/month for >3 months

8

Define retinal migraine

Aura of fully reversible monocular positive and/or negative visual phenomena confirmed during an attack by either or both of:
1. Clinical visual field examination
2. Pt's drawing of a monocular field defect

9

Define brainstem aura

Aura of fully reversible visual, sensory and/or speech/language sx's, BUT NO motor or retinal

10

Define Hemiplegic Migraine

Aura consisting of both fully reversible:
1. Motor weakness
2. Visual, sensory and/or speech/language sx's

11

What is first line treatment in abortive therapy for mild-moderate migraine HA's?

NSAIDs

12

What is second line treatment in abortive therapy for mild-moderate migraine HA's?Indications?

Acetaminophen
1. Patient failed NSAIDs
2. CI to NSAIS: HTN, Warfarin therapy, renal failure, GI issues, allergy

13

What is a common cause of medication-overuse headache?

ASA/Acetaminophen/Caffeine (Excedrin)-->only for intermittent use!

14

What is first line treatment in severe migraine attacks (abortive)?

Serotonin (5-HT1) Agonistis: "Triptans"
-Sumatriptan (Imitrex)

15

What is second line treatment in severe migraine attacks (abortive)?

Ergotamines

16

Ergotamines MOA

Non-selective serotonin (5HT1) agonists
-Less effective
-More adverse effects

17

What is last line treatment in severe migraine attacks (abortive)?

Opiods

18

Indication for migraine prophylaxis/prevention

1. Migraine > or equal to 3 days/month
2. Duration >48 hrs
3. Acute tx CI, ineffective, or overused

19

What was recently approved by the FDA for chronic migraines?

Botulinum Toxin

20

Migraine prevention treatment

1. Anti-HTN meds: BB (propanolol), CCB (Verapamil)
2. Anticonvulsants: Valporic acid
3. Antidepressants: Amitriptyline

21

What is the most common primary headache disorder?

Tension headaches

22

Tension HA clinical findings

1. Daily or episodic HA that last from 30 min-7 days
2. Bilateral location
3. Pressing/tightening quality (non-pulsating)
4. Not increased with basic activity
5. N/V,photophobia/phonophobia are rare

23

What is first line treatment for tension-type HA's?


1. NSAIDS: Ibuprofen, Naproxen
2. Acetaminophen
3. ASA

24

Classification of chronic tension-type headaches

>7-9 HA/mo

25

What is the most effective treatment for chronic tension-type HAs?

Amitriptyline

26

Non-pharmacologic therapy for tension-type HAs

1. Cognitive Behavioral Therapy
2. Relaxation training
3. EMG biofeedback

27

What is the least common primary headache disorder?

Cluster headaches?

28

Risk factors for for Cluster headaches

1. MALE
2. Cigarette smoking
3. High alcohol consumption
4. Type A personality

29

Cluster HA presentation

1. Severe unilateral, supraorbital and/or temporal HA attacks
2. Lasts for 15-180 minutes up to 8x/day
3. Pain peaks within 10-15 minutes after onset

30

What is the MC form of cluster headaches?

Episodic:
-Attack phases last 2-16 weeks
-Followed by cluster free period of 6 mos.-1 yr

31

List the sx's that are present on the affected side (one must be present)

SLUDE:
1. Conjunctival injection and/or lacrimation
2. Nasal congestion and/or rhinorrhea
3. Eyelid edema
4. Sweating-Forehead and facial
5. Miosis and/or ptosis

32

What can a cluster headache be misdiagnosed with?

Horner's Syndrome

33

Cluster headache acute attack 1st line treatment

1. 100% oxygen
2.Sumatriptan(Imitrex)/Zolmitriptan(Zomig) =only FDA approved med

34

Who are Triptans CI in?

1. HTN
2. Vascular dz

35

Cluster Headache Prophylaxis

CCB Verapamil

36

Verapamil contraindications

1. Heart block
2. Arrhythmias

37

what is the primary use of CT/MRI in the case of a concussion?

Rule out intracranial hemorrhage

38

What are the variables that predict intracranial hemorrhage in pediatric patients?

1. LOC
2. GCS<15
3. Skull fracture
4. Focal neurological defect

39

List the Diagnostic criteria for analgesic rebound headache

1. Simple analgesic use >or equal to 15 days/mo x3months in a patient with a pre-existing HA disorder
2. HA resolves/reverts to previous pattern within 2 months after discontinuation of analgesics

40

What is the most significant factor in the development of rebound headaches?

Lack of awareness by HC practitioner and patient

41

What is the other name for pseudotumor cerebri?

idiopathic intracranial hypertension

42

Who do pseudotumor cerebri primarily affect?

Women of childbearing age

43

What are the associated sx's observed in pseudotumor cerebri?

1. Transient visual obscurations: Dimming or blackout in one or both eyes
2. Intracranial noises: Pulsatile tinnitus
3. Photopsia
4. Retrobulbar pain
5. Back pain
6. Diplopia
7. Sustained visual loss

44

pseudotumor cerebri physical exam findings

1. Papilledema
2. Visual field loss
3. Abducens (CN VI) Palsy: Horizontal diplopia

45

What are some conservative treatment options for pseudotumor cerebri?

1. Wt loss for obese pt's
2. Decrease sodium intake
3. Carbonic anhydrase inhibitors: Acetazolamide
4. Loop Diuretics (adjunct)

46

What is no longer recommended in pseudotumor cerebri?

Corticosteroids

47

What are some more invasive treatment options for pseudotumor cerebri?

1. Serial LP's: temporary basis to help provide symptomatic relief
2. Optic nerve fenestration: "Window" in optic nerve sheath
3. CSF shunting

48

Temporal arteritis etiology

Systemic inflammatory vasculitis of unknown etiology

49

What is the peak age of incidence in Temporal arteritis?

70-79 y.o.

50

Temporal arteritis clinical presentation

1. Abrupt or insidious
2. HA-Temporal or occipital area
3. Polymyalgia rheumatic
4. Jaw claudication
5. Fever

51

What is the hallmark of GCA?

1. Elevated ESR
2. Elevated C-reactive protein

52

What is the standard for making the diagnosis of temporal arteritis?

Temporal artery biopsy

53

Temporal arteritis treatment

High-dose corticosteroids: Prednisone

54

When can you start to taper the prednisone?

1. Signs of clinical inflammation are suppressed
2. ESR and CRP remain low

55

What is another name for Trigeminal Neuralgia

“Tic Douloureux”

56

Who is Trigeminal neuralgia 20x more common in?

Multiple sclerosis patients

57

What is the MC cause of Trigeminal neuralgia?

Compression of trigeminal nerve root by cerebellar artery or vein

58

Describe clinical presentation of Trigeminal neuralgia?

1. Sharp, electrical, shock, UNILATERAL facial pain lasting few seconds to several minutes
2. Pain triggered by chewing, t talking, smiling, shaving, cold air
3. Pain starts near mouth to angle of jaw

59

What is first line treatment for Trigeminal neuralgia?

Anti-convulsant and antidepressant= Carbamazepine (Tegretol)

60

What is the best long term outcome treatment for Trigeminal neuralgia?

Surgical decompression

61

What is the majority of causes of subarachnoid hemorrhages?

Ruptured saccular aneurysms

62

Risk factors for subarachnoid hemorrhages?

1. Uncontrolled HTN
2. Smoking
3. Alcohol