headaches/parkinsons

Question 1

symptoms that can occur with cluster headaches

Answer 1

Along with the headaches
Runny nose
Watery eyes
Drooping eyelid
Blushing

Question 2

Acute attack tx for cluster HA

avoid what

Answer 2

Oxygen!!!
Triptans(IV)
Opioids are just as likely to make things worse

Question 3

Cluster HA Preventive therapy

Answer 3

Calcium channel blockers – Verapamil
Steroids may be used in the first few days.
Lithium

Question 4

migraine

• describe HA
• what occurs in 30% of pts

Answer 4

Typically unilateral headache of moderately severe pulsating pain.
Auro occurs in about 30% of patients
Classic migraine = aura
Common migraine = no auro

Question 5

migraine

• duration
• FH?
• age

Answer 5

Usually lasts between 2 and 72 hours
There is often a family history of migraines
Before puberty more boys than girls. After puberty more women than men.

Question 6

other diseases migraines are associated with

Answer 6

seizures, essential tremor, tourette syndrome, depression, anxiety, stroke

Question 7

aura

• describe
• duration
• location

Answer 7

visual changes, field cuts, flashing lights
lasts several minutes to less than 1 hr
throbbing pain is contralateral to aura

Question 8

Recurrent severe headaches
They become worse if I move at all
Nausea/vomiting
Sensitivity to light and sound

Answer 8

migraine

Question 9

pathophysiology of migraines

Answer 9

attributed to intracranial vasospasm followed by extracranial vasodilatation

Question 10

Prophylactic treatment of migraines

Answer 10

Beta blockers – metoprolol, propranolol
Calcium Channel blockers – verapamil
ACE inhibitors
Tricyclic antidepressants

Question 11

Most common type of headache

Answer 11

Most common type of headache making up about 90% of all headaches: Tension

Question 12

Causes include
Stress
Lack of sleep
Hunger
Minor head and neck trauma

Answer 12

tension HA

Question 13

Constant pain like my head is in a vice

Answer 13

tension HA

Question 14

tension HA tx

Answer 14

Analgesics

first line: NSAIDs and Acetaminophen

Question 15

Unilateral headache with a runny nose that occurs at 1:30 everyday for the past week?

Answer 15

Cluster headache

Question 16

Oxygen therapy is used in the acute setting of which headache?

Answer 16

Cluster headache

Question 17

Which type of headache is associated with an aura?

Answer 17

Migraine

Question 18

severe, unilateral, periorbital HA that lasts 30-90 minutes and occur several times a day over a period of weeks to months

Answer 18

cluster

Question 19

typical pt with cluster HA

Answer 19

middle aged man, often without a FH of migraine and HA

Question 20

cluster HA has a ___ etiology and evidence of serotonergic mechanism

Answer 20

vascular

Question 21

pt presentation with a cluster HA that is atypical compared to the usual HA

Answer 21

often pace incessantly around the room because pain is severe and not relieved by rest

Question 22

Often called familial tremor because it may follow an autosomal dominant pattern.
Most common movement disorder

Answer 22

essential tremor

Question 23

Uncontrollable rhythmic movement typically involving the hands, tongue or head.
The tremor may occur at rest, but is more commonly seen when the patient attempts to use the affected muscles.

Answer 23

essential tremor

Question 24

essential tremor gets worse with what

Answer 24

The tremors get worse with fatigue, stress, caffeine as well as many other triggers.

Question 25

essential tremor tx

Answer 25

Avoidance of fatigue, stress, caffeine etc First line medical treatment is with Beta blockers propranolol/ use primidone if BB fails Second line include anti epileptics topiramate gabapentin Second line also includes benzodiazepines alprazolam Patients may self medicate with alcohol as is it provides dramatic relief.

Question 26

essential tremor - cause - inherited? - age - enhanced with what - disability

Answer 26

``` unknown cause often inherited in an autosomal dominant manner any age enhanced by emotional stress minimal disability ```

Question 27

essential tremor - affects what extremities - speech

Answer 27

usually upper extremities | speech can be affected if laryngeal muscles involved

Question 28

Degenerative disorder of the central nervous system | describe disease

Answer 28

Parkinsons There is an imbalance between acetylcholine and dopamine due to the death of cells in the substantia nigra which normally produce dopamine

Question 29

Parkinsons age depression and cognitive impairment

Answer 29

45-65 | 50%

Question 30

``` Resting or pill rolling tremor Bradykinesia Rigidity – Lead-pipe or cogwheel Postural Instability Festination (rapid shuffling gait) Difficulty getting up from a chair, difficulty with stairs ```

Answer 30

Parkinsons Motor function Resting or pill rolling tremor – begins in one limb or on one side but will spread Bradykinesia (slow movements) – reduced arm swing, mask like facies, infrequent blinking Rigidity – Lead-pipe or cogwheel Postural Instability Festination (rapid shuffling gait) Difficulty getting up from a chair, difficulty with stairs

Question 31

``` Psychiatric Loss of executive function problem solving planning Inhibition of inappropriate actions Speech disorders Behavior and mood alterations Depression Anxiety Dementia ```

Answer 31

Parkinsons

Question 32

``` Autonomic Nervous System Urinary Incontinence Orthostatic Hypotension Excessive sweating Constipation or gastric motility Eye and vision abnormalities ```

Answer 32

Parkinsons

Question 33

``` Neuropsychiatric Loss of executive function problem solving planning Inhibition of inappropriate actions ```

Answer 33

Parkinsons

Question 34

CT or MRI in Parkinson’s

Answer 34

CT or MRI are normal in Parkinson’s, but used to rule out other causes of neurologic symptoms

Question 35

Lewy Bodies may be seen on an autopsy of the brain in…

Answer 35

Parkinson’s disease Dementia with Lewy bodies Multiple system atrophy Alzheimer’s disease

Question 36

Medications goal in parkinsons

Answer 36

Medications (you can either increase dopamine or decrease acetylcholine)

Question 37

most helpful with mild motor symptoms in parkinsons

Answer 37

Anticholinergics Amantadine Benztropine

Question 38

the number one medication for Parkinson’s disease

Answer 38

Levodopa

Question 39

Levodopa MOA and SE

Answer 39

Mechanism of action Levodopa is converted to to dopamine within the body and results in decrease the motor symptoms of Parkinson’s disease. Side effects No more than 10% of Levodopa crosses the blood brain barrier Nausea Dyskinesia (tics and chorea) Need to reach a balance between rigidity, bradykinesia and dyskinesia

Question 40

Peripheral dopa decarboxylase inhibitors

Answer 40

slow the process of levodopa → dopamine outside of the brain Carbidopa Benserazide

Question 41

Catechol-O-methyltransferase inhibitor (COMT inhibitors) | Tolcapone

Answer 41

– COMT breaks down dopamine

Question 42

Bromocriptine | Pergolide

Answer 42

Dopamine agonists work on dopamine receptors

Question 43

MAO-B inhibitors Selegiline Rasagiline

Answer 43

These block the metabolism of dopamine thereby increasing the concentration in the basal ganglia. may arrest the progression of the disease

Question 44

Parkinson's surgical tx Deep Brain Stimulation Ablative brain surgery Pallidotomy

Answer 44

Deep Brain Stimulation – involves the implantation of a brain pacemaker, which sends electrical impulses to specific parts of the brain. Ablative brain surgery Pallidotomy – A small probe is place into the globus pallidus and then heated to almost 200 degrees.

Question 45

The term pill rolling tremor should make you think of what diagnosis?

Answer 45

Parkinson’s

Question 46

Cell death in what area of the brain results in parkinsonism?

Answer 46

The substantia nigra

Question 47

rule out what with tension HA in pts over 50 y/o

Answer 47

giant cell arteritis, get ESR