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Clin Med, Path, Pharm > Neuro: Headaches > Flashcards

Neuro: Headaches Flashcards

(52 cards)

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1
Q

The headache and associated symptoms are the disorder itself

A

Primary headaches

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2
Q

Types of primary headaches

A 
Migraine
Tension
Cluster
Paroxysmal Hemicrania
Chronic Daily HA
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3
Q

Types of secondary headaches

A 
Infection
Mass
Hemorrhage
Temporal Arteritis
Glaucoma
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4
Q

What are the four phases of migraine headache?

A

Prodrome
Aura (+/-)
Headache
Postdrome

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5
Q

Two categories of migraines

A

WIth aura and without aura

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6
Q

Euphoria, depression, irritibaility, food cravings, constipation, neck stiffness, and increased yawning are examples of what?

A

Prodromal symptoms

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7
Q

What are the four types of aura?

A

Visual
Sensory (tingling, numbness)
Verbal
Motor disturbances (weakness to hemiparesis)

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8
Q

Common migraine triggers

A 
Glare
Sounds
Hunger
Stress
Physical exertion
Stormy weather
Hormonal changes
Lack of sleep
Alcohol/chemical stimulation
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9
Q

MIgraine pathophysiology

A

Cortical spreading depression (wave of depolarization that spreads across the cerebral cortex)
Neurovascular system becomes hyperexcitable
Activation of trigeminal nerve terminal

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10
Q

What happens as a result of activation of trigeminal nerve terminal in migraine headache?

A

release of CGRP, seratonin, and inflammatory cytokines

also substance P, neurokinin A, glutamate, and prostaglandin

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11
Q

What stage should migraines ideally be treated in?

A

When pain is at first generation neurons in trigeminal nucleus caudalis

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12
Q

What happens if migraines are not treated adequately in first stage?

A

2nd and 3rd generation neurons are activated. Cutaneous allodynia results
Meds are less effective here

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13
Q

What is important in treatment of acute migraines?

A

Activation of serotonin receptors

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14
Q

Vasodilator associated with migraines

A

CGRP

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15
Q

Who should get imaging studies with migraines?

A

Most patients don’t need it.
Recommended in pts atypical features, sudden severe HA (r/o SAH)
First or worst headache
unexplained neuro symptoms
New onset after 50
not responding to tx
sx suggesting meningitis or encephalopathy

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16
Q

Meds taken within first 1-3 hours of onset of migraine

A 
Rescue meds
NSAIDS (Toradol, advil, naproxen, diclofenac)
Triptans
Ergots
Antiemetics
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17
Q

How many migraines warrents the need for prophylactic meds?

A

> 4 migraines/month

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18
Q

What are examples of preventative migraine meds?

A

antiepileptic drugs
Beta blockers
Antidepressants

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19
Q

What combination of meds is often used at migraine onset?

A

NSAID and triptan

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20
Q

MOA of triptan

A

serotonin agonist. Inhibit the release of vasoactive peptides, promote vasoconstriction, and block pain pathways. Inhibit transmission in trigeminal neuclus caudalis

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21
Q

Available triptans

Study These Flashcards
A

SUmatriptan, zolmitriptan, naratriptan, rizatriptan, almotripan, eletriptan, frovatriptan

22
Q

Who should NOT take triptans?

Study These Flashcards
A

pts with stroke, heart disease, uncontrolled HTN, pregnancy, or in someone who used Ergotamine preparations within the last 24 hours

23
Q

SE of triptans

Study These Flashcards
A

paresthesia, dizziness, flushing, chest pain, diaphoresis, N/V, myalgias

24
Q

What antiemetics are used in acute treatment of migraines?

Study These Flashcards
A

Reglan, cholrpromazine, procholrperazine, droperiodl

25
What is sometimes given with antiemetics to prevent akathisia and acute dystonia side effects?
Benadryl
26
What should you always give when you are prescribing an Ergot (dihydroergotamine, DHE45)
Antiemetic | can cause severe nausea
27
MOA: alpha-adrenergic blocker that directly stimulates vascular smooth muscle to vasoconstrict peripheral and cerebral vessels
Dihydroergotamine (DHE45)
28
C/I of Dihydroergotamine
Uncontrolled HTN, heart disease, angina, hemiplegic migraine, PVD, sepsis, severe hepatic/renal function. Cannot use within 24 hours of triptan
29
Used for migraines lasting longer than 72 hours (status migrainosis)
Steroids (Dexamethasone and Prednisone)
30
What are preventative treatments for migraines?
Antihypertensives (BB, ACEI, CCB, ARBs), Antidepressants, Anticonvulsants
31
You prescribe metoprolol for preventative treatment of migraines. One month later your pt is saying its not working and would like to switch. What do you say?
Takes at least 3 months of an effective dose before you can say the med is a failure
32
beta blockers used in preventative treatment of migraines
Metoprolol Propanolol Timolol
33
What antidepressants are given for migraine preventative treatment?
TCAs
34
SE of TCAs
``` anticholinergic SE tachy, palpitations Ortho hypotension weight gain blurred vision ```
35
What anticonvulsants are used to prevent migraines?
Valproate (Depakote) Topiramate (Topamax)
36
C/I of Valproate
pregnancy | do NOT use in women of child bearing age
37
C/I of Topiramate (Topamax)
Hx of kidney stones, GLAUCOOMA
38
Role of butterbur, feverfew, magnesium, and vitamin b12 with migraines
MAY be beneficial
39
most prevalent headache in the general population
Tension
40
What categorizes someones tension HAs to be infrequent? frequent? chronic?
Infrequent: <1 month Frequent: 1-14 days/month x 3 months Chronic: 15+ days/month
41
Difference in pathophys of tension HA vs migraine HA
Tension: primary d/o of CNS pain modulation alone Migraine: generalized disturbance of sensory modulation
42
Feature that distinguishes tension from migraine
muscle contraction
43
Only proven treatment for tension headaches
Amitriptyline (Elavil)
44
Headaches in Trigeminal Autonomic Cephalgias
Cluster headaches Paroxysmal hemicrania SUNCT
45
Cluster headaches that occur daily (1-8x/day) for several weeks, followed by a period of remission
Episodic cluster headache
46
Cluster headaches that occur daily (1-8x/day) without remission
Chronic cluster headache
47
Autonomic clinical features of cluster headache
Ptosis, miosis, lacrimation Conjunctival injection Rhinorrhea Nasal congestion
48
Theories of pathophys of cluster headache
1. hypothalamic activation (trigeminal atuonomic reflex is then activated) 2. inflammation of cavernous sinus that injures traversing sympathetic fibers of carotid artery
49
Neuroimaging in Cluster
suggested with MRI brain w and w/o contrast or CT to exclude brain and pituitary gland abnormalities
50
Treatment of choice to prevent cluster headaches
Verapamil (Calan) | Steroids, topamax, and lithium may also be used
51
First line acute rescue treatment of cluster ha
Oxygen inhalation AND | SQ or nasal Sumatriptan or Zolmitriptan
52
Complete line of acute rescue tx for cluster headaches
Oxygen inhalation and triptan (first line) DHE Lidocaine (IN) Octreatide

Clin Med, Path, Pharm (12 decks)

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