Headaches Flashcards
(53 cards)
1
Q
What HA are considered primary HAs?
A
- Chronic, benign, recurring headache without known cause
ie. Migraines, tension-type headaches, cluster headaches
2
Q
What HA are considered secondary HAs?
A
- HA due to underlying pathology
ie. Space-occupying mass, infection, head trauma
3
Q
What the “red flags” associated with headaches that represent potential emergencies?
A
- Sudden onset within seconds to minutes.
- Worst headache of patient’s life.
- New-onset headache that the patient has never experienced before, especially > 50 years of age.
- Headache pattern: increase in severity and frequency over time, worse with lying down.
- Mental status change or any focal neurological signs/symptoms.
- New headache associated with heavy exertion or head trauma, fever, stiff neck, or rash, HIV infection or cancer.
4
Q
What are the SNOOP4 red flags?
A
- Systemic disease or symptoms
- Neurologic signs or symptoms
- Onset that is sudden
- Older than 40 years of age
- Progressive worsening
- Postural
- Precipitated by Valsalva maneuver or exertion
- Previous headache history with new feature
5
Q
What are the general characteristics of migraine HAs?
A
A chronic headache syndrome caused by a neurovascular disorder
- neural events lead to intracranial vasodilation (also thought that serotonin is involved somewhere in the pathway)
6
Q
What are the general types of migraine HAs?
A
- Migraine with aura
(15% of cases = “classic migraine”) - Migraine without aura:
(85% of cases = “common migraine”)
7
Q
What are the clinical features of migraine HAs?
A
- Severe, throbbing, unilateral headache (not always on the same side)
- Lasts 4 to 72 hours
8
Q
What are some sxs of migraine HAs?
A
- Nausea and vomiting (in as many as 90% of cases)
- Photophobia
- Increased sensitivity to smell
9
Q
What is the tx for an acute attack for migraine HAs?
A
- NSAIDs
- Dihydroergotamine (DHE)
- Sumatriptan and related “triptans”
10
Q
What is the 1st line prophylaxis tx for migraine HAs?
A
- Beta-blockers (propranolol and timolol)
- Antidepressants - amitriptyline and venlafaxine
11
Q
What is the 2nd line prophylaxis tx for migraine HAs?
A
- Verapamil (calcium channel blocker)
- Anticonvulsants: valproic acid or topiramate
- Methylsergide
12
Q
What are the general characteristics of tension HAs?
A
Most common type of headache overall
13
Q
What are the clinical features of tension HAs?
A
- Pain is steady, aching, “vise-like,” and encircle the entire head (tight- band-like pain around the head)
14
Q
Where is the MC location of pain caused by tensions HAs?
A
- Most intense around the neck or back of the head
- Can be accompanied by tender muscles (posterior cervical, temporal, frontal)
- Tightness in posterior neck muscles
15
Q
What is the tx for mild to moderate tension HAs?
A
- Evaluate the patient for depression or anxiety
- Stress reduction is important
- NSAIDs, acetaminophen, and aspirin
16
Q
What is the tx for severe tension HAs?
A
- Medications that are used for migraines
ie. Dihydroergotamine (DHE), Sumatriptan and related “triptans”
17
Q
What are the clinical features of cluster HAs?
A
- Excruciating periorbital pain (“behind the eye”)
- Almost always unilateral
- Cluster headache is described as a “deep, burning, searing, or stabbing pain”
- Pain may be so severe that the patient may even become suicidal
18
Q
What other sxs are seen in cluster HAs?
A
- Ipsilateral eye pain and lacrimation
- Ipsilateral facial flushing/sweating
- Ipsilateral nasal stuffiness or rhinorrhea
19
Q
When do cluster HAs usually appear?
A
- Awakens the patient from sleep
- Attacks occur nightly for 2 to 3 months and then disappear
- Remissions may last from several months to several years
- Worse with alcohol and sleep
20
Q
What is the abortive 1st line tx for cluster HAs?
A
Inhaled O2
21
Q
What is the prophylaxis tx for cluster HAs?
A
Verapamil PO daily
22
Q
What causes a medication overuse HA?
A
Regular overuse for >3 months of acute medications
23
Q
What are the medications that can cause and overuse HA?
A
- Ergot, triptan, opioid, or butalbital analgesics >10 days per month
- Nonopioid analgesics > 15 days per month
- All acute drugs > 15 days per month
24
Q
What is the etiology of secondary morning HAs?
A
- Primary sleep disturbance
- Abnormal sleep duration
- Secondary to another disease (sleep apnea)
25
S/sx of infection-related migraines (meningitis)?
- A severe HA that is different from any HA before
| - Accompanied by fever, stiff neck, or a focal neurologic abnormality not documented with the pts previous HA.
26
How do you differentiate between meningitis and SAH?
- More abrupt HA onset = SAH> meningitis
| - Fever = meningitis > SAH
27
What LP findings would be indicative of a bacterial infection?
- Turbid
- Protein: > 1g/L
- Glucose: < 40 mg/dL
28
Viral meningitis most commonly involves what?
Enteroviruses
29
Viral encephalitis most commonly involves what?
Arboviruses
30
How is Herpes Simplex Virus (HSV) Encephalitis treated?
Treat with Acyclovir
31
What is the diagnostic criteria for Temporal Arteritis?
- Must meet 3 of the 5 criteria
- Age > 50 years
- New-onset localized headache
- Temporal artery tenderness or decreased pulse
- ESR > 50 mm/hr
- Abnormal arterial biopsy findings
32
What are the clinical features of sinus HAs?
- Usually NOT associated with nausea, vomiting, photophobia, or phonophobia
- Sinus tenderness d/t congestion, associated with sinusitis.
33
Since spheroids are harder to diagnosis clinically what do you need to be cautious off?
Higher risk of meningitis = longer abx (IV)
34
Trigeminal Neuralgia is also known as what?
- Tic douloureux
| - "the suicide disease"
35
What are the s/sx of Trigeminal Neuralgia?
- One of the most painful conditions
- MC in middle-aged women
- Brief (seconds to minutes) but frequent attacks of severe, lancinating facial pain
36
What part of the face does Trigeminal Neuralgia involve?
- Jaw, lips, gums, and maxillary areas (ophthalmic division is less commonly affected
37
Trigeminal Neuralgia pain worsens with what?
- Chewing, talking, touching face, wind in face.
38
What is the tx for Trigeminal Neuralgia?
- Carbamazepine
39
What are the clinical features of Glossopharyngeal Neuralgia?
- Occurs in the throat (about the tonsillar fossa) and sometimes deep in the ear and at the back of the tongue
- May be caused by MS
40
What is the tx for Glossopharyngeal Neuralgia?
Carbamazepine or Oxcarbazepine
41
What is the Etiology of Subarachnoid Hemorrhage?
- MC: rupture of an intracranial aneurysm
| - Second MC: the rupture of an arteriovenous malformation (AVM)
42
What is the clinical features of Subarachnoid Hemorrhage?
Thunderclap/"Worst headache of my life!"
43
What are some diagnostic test used to dx Subarachnoid Hemorrhage?
- CT w/o contrast
- Lumbar puncture: xanthochromia
- Cerebral angiography
- ECG
44
Why is a cerebral angiography done in a pt with Subarachnoid Hemorrhage?
Shows the localization of the site of aneurysm or rupture prior to neurosurgical intervention
45
What is seen on the ECG in a pt with Subarachnoid Hemorrhage?
- ST segment changes consistent with an ischemic process
- QRS complex widening
- QT prolongation
- Inverted T waves
46
What is Idiopathic Intracranial Hypertension?
Increased ICP with no other cause of intracranial hypertension noted via CT or MRI.
47
Idiopathic Intracranial Hypertension is MC'ly seen in who?
Obese women of childbearing age
48
What is the tx for Idiopathic Intracranial Hypertension?
Acetazolamide
| reduces CSF pressure and production
49
What are S/Sx of Post-Concussion Syndrome?
- Grossly observable incoordination (stumbling, inability to walk tandem/straight line)
- Vacant stare
(befuddled facial expression)
- Delayed verbal expression
(slower to answer questions or follow instructions)
- Inability to focus attention
(easily distracted, unable to "follow through")
- Disorientation
(walking in wrong direction, unaware or time or place)
- Slurred or incoherent speech
(disjointed or incomprehensible statements)
- Emotionally out of proportion to circumstances
(distraught, crying for no apparent reason)
- Memory deficits
(repeating questions, impaired recall)
50
What is the tx for SAH?
Nimodipine to prevent vasospasm
51
What is the MC space-occupying lesion and what is the sx??
Meningioma
| - Focal neuro deficits
52
How do you dx a space-occupying lesion?
CT w/ contrast
53
What is the sxs of Idiopathic Intracranial Hypertension?
Visual changes, papilledema, CN VI palsy
