Neuro Flashcards
(27 cards)
Where are Beta 2
Vessels (dialate)
Uterus (dialate)
Bronchioles
Where are Alpha 1?
Eye (dilates)
Vessels
Bladder (sphincter)
Where are Beta 1
Think cardiac
Where are Alpha 2 receptors
Decrease insulin
Decrease prejunctional NT release
Migraine etiology?
Headaches results from dilation of blood vessels innervated by the trigeminal nerve and peripheral sensitization caused by release of neuropeptides such as calcitonin gene related peptide.
Must have 5 episodes to call it a migraine
Migraine prevalence and s/s?
Onset often in adolescence or early adult life. More often women
S/sx: Usually lateralized throbbing h/a that occurs episodically; unilateral
May last between 4-72 hours
Pain qualities: unilateral, throbbing, worse with movement, moderate/severe + associated symptoms
Migraine associated symptoms?
Aura
Visual disturbances
Other focal disturbances: aphasia, numbness, parethesias, etc.
Migraine equivalent: rare, the neuro or somatic distubances that accompany typical migraines become the sole manifestation of an attack
Migraine: workup and management:
Work up: family hx, HA diary: lack or excess of sleep, missed meals, specific foods, alcohol, bright lights, loud noises
Tx: Symptomatic: rest in dark room, NSAIDs or tylenol or meds see specific question
Prophylaxis: Antiepileptic meds, CV drugs, TCAs
Cluster headache etiology?
And prevalence
Exact cause unknown, but thought to be linked to body’s biologic clock the hypothalamus
Prevalence: middle aged men, thin, smokers, drinkers
Cluster HA, s/sx
Severe unilateral periorbital pain that occurs daily for several weeks and often accompanied by one of the following:
- ipsilateral nasal congestion, rhinorrhea, lacrimation, redness of the eye, horner syndrome (ptosis of eyelid, meiosis or constriction of the pupil, anhidrosis or reduction of sweat secretion)
Episodes typically occur at night, awaken pt., duration 15min-3 hours, bouts last 4-8 wks. 5 epidsodes for diagnosis
Cluster HA, workup, tx?
Work up: check for triggers such as EtoH, stress, glasre, ingestion of specific foods
Tx: Oral drugs usually don’t help. SubQ or intranasal sumatriptan or 100% o2 may help.
Prophylaxis: lithium, verapamil, topiramate, valproate
Tension HA etiology?
Prevalence?
may be emotional stress, fatigue, noise or glare
P: most common type of primary HA disorder
Tension HA s/s?
Pericranial tenderness, poor concentration.
May have constant daily HA, that are often vise like or tight in quality but not pulsatile. Usually generalized.
May be most intense about the neck or back of head.
Tension HA work up, tx
H&P, assess for comorbid anxiety and depression. Normal neuro exam
Tx: Similar to migraines but not triptans
Giant cell (temporal arteritis)
Eti: autoimmune disored that typically affects medium and large arteries
Rare in those less than 50
S/sx: fever, fatigue, HA, pain in tongue and jaw
Dx: temporal lobe biopsy, elevated sed rate, localizedHA
Post-concussive headache
Eti: following a head injury
Common after TBI
s/sx: usually appears within a day of injury, may worsen with time. Usually constant dull ache with superimposed throbbing
Dx: CT, MRI usually normal
Tx: treatment difficult, may respond to simple analgesics
Prog: go away with time
Headache due to a mass lesion. Eti
Eti: intracranial mass lesion, may also result in increased ICP.
Cancer that metastasizes to the brain: lung, breast, and melanoma
Headache due to a mass lesion. S/sx, dx, tx
H/A are nonspecific and may vary in severity from mild to severe.
May worsen with exertion or postural change.
Dx: CT if HA changes from normal or gets worse
Tx: Consult neuro
Rebound headache (medication overuse ha) Eti?
Eti: Medication overuse. analgesic rebound. Frequency based, not strength of dose.
Must have dx of migraines
HA at least 15 days/month
Regular overuse of meds for greater than 3 months.
Regular intake of drugs for more than 10 days per month
Rebound headache (medication overuse ha): s/sx, dx, tx
Prevalence: occurs in half of all pt. with chronic daily HA
S/sx: dull, mild to moderate pain. Bilateral, frontal occipital or diffuse, often lasts at lease 4 hours a day
Tx: withdraw medication/substance
Sumatriptan: MOA, Indication, CI, AE, etc.
MOA: 5-HT1 (serotonin) receptor agonist.
Ind: Good abortive meds for migraines
CI: ischemic heart disease, uncontrolled HTN
AEs: dixxiness, local injection site reaction, flushing, chest discomfort
Dosing: SubQ, intranasal, PO
Rizatriptan, Zolmitriptan: Indication, CI, AE, etc.
Migraines
CI: ischemic heart disease, CV disease, coronary artery vasospasm, hx of stroke or TIA
AE: chest pain, dizziness, somnolence, fatigue, tingling, nausea
PO
Dihydroergotamine (Migranal)
MOA: bind to 5-HT1, alpha and dopamine receptors Indications: severe migraines CI: angina or peripheral vascular dz. AE: nausea and heart issues Black box: CYP3A4 inhibitor Preg cat x Route: IV, intransal, IM
Divalproex (Depakote)
MOA: increased GABA availability
Indic: Migraine prophylaxis, seizures, mania
CI: hepatic disease, pregnancy, mitochondrial disorders
AE: sedation, N/V, thrombocytopenia, hepatotoxicity
BLACK BOX: hepatotoxicity
