Neurology 2.8

Question 1

What is the main triad of a migraine?

Answer 1

• incapacitating (disability)
• nausea/emesis (nausea)
• light/sound sensitivity (photophobia)

Question 2

What else are patients with migraines at risk for if they smoke?

Answer 2

9x’s increased risk of stroke

Question 3

What else are patients with migraines at risk for if they take oral contraceptives?

Answer 3

7x’s increased risk of stroke

Question 4

What is the relationship between serotonin and migraines?

Answer 4

• low serotonin levels in migraine sufferers
• serotonin is a vasoconstrictor as one of its functions
• triptans (functionally similar to serotonin) blocks inflammatory chemicals in meninges and inhibits pain transmission

Question 5

What is a “modulator zone”?

Answer 5

active zone in the dorsal raphe nucleus of the midbrain during a migraine attack

Question 6

What is allodynia?

Answer 6

painful reaction to otherwise non painful stimuli; develops as migraine attacks progress

Question 7

What is central sensitization?

Answer 7

central amplification of pain response and threshold in migraines; chronic

Question 8

What is neuronal sensitization?

Answer 8

process where neurons become increasingly responsive to pain stimuli in chronic migraines

Question 9

What are the results of sensitization in migraines?

Answer 9

• decreased response threshold
• increased response magnitude
• expansion of receptive fields

Question 10

What categorizes migraines as chronic or transformed migraine?

Answer 10

progressive form of migraine intermittent attacks, eventually to 15+ days/month

Question 11

What is the most effective treatment for cluster headaches?

Answer 11

oxygen; most patients with cluster headaches are smokers

also, triptans and occipital nerve blocks

Question 12

What is the typical presentation of cluster headaches?

Answer 12

• watery eye
• drooping eye
• runny nose
• male

Question 13

Are most patients who present with migraine/headache symptoms primary or secondary in etiology?

Answer 13

primary; >99%

Question 14

Do brain tumors typically present with headaches?

Answer 14

No; explains why imaging is not always typical for a headache patient unless there is neurological deficit

Question 15

When should a physician consider an intracranial hematoma as a potential diagnosis?

Answer 15

• recent trauma with a cute changes in mental status
• headache
• focal neurological deficit

Question 16

How are stroke and Bell’s palsy differentiated?

Answer 16

Bell’s palsy:
-three divisions of trigeminal loss of function in face

stroke:
-patient can still furrow the forehead

Question 17

Do subdural hematomas affect veins or arteries? Will it kill you?

Answer 17

• veins

- no

Question 18

Do epidural hematomas affect veins or arteries? Will it kill you?

Answer 18

• arteries

- yes

Question 19

What is trigeminal neuralgia?

Answer 19

• sharp facial pain due to irritation of trigeminal nerve

- triggered by crushing teeth,etc.

Question 20

What causes the facial pain felt in Multiple Sclerosis?

Answer 20

demyelination of trigeminal nerve

Question 21

What is carotidynia?

Answer 21

pain which eminates from the coratid artery

Question 22

What is giant cell arteritis?

Answer 22

temporal arteritis; vasculitis of large and medium sized arteries;

• temporal artery distended
• jaw chewing fatigue
• claudication
• *treat with steroids**

Question 23

What are the most common presenting signs and symptoms of TMJ?

Answer 23

• pain-ear discomfort
• headache
• TMJ discomfort or dysfunction

Question 24

What pathology is a sudden severe headache described as “worse in my life” a classic red flag?

Answer 24

subarachnoid bleed

also,
coratid artery dissection