Neurology Flashcards
(204 cards)
1
Q
pupil size in coma:
- one dilated, nonreactive or sluggish pupil
- cause
- examples
A
- cause: parasympathetic nerve problem
- oculomotor nerve compression from uncal herniation
- aneurysm of posterior
- communicating artery
2
Q
pupil size in coma:
- one pinpoint pupil (miosis)
- cause
- examples
A
- cause: sympathetic nerve problem (Horner)
- lateral medullary syndrome- hypothalamus injury- Pancoast tumor- carotid dissection
3
Q
pupil size in coma:- two midpoint, nonreactive pupils- cause- examples
A
- cause: parasympathetic and sympathetic nerve destruction- midbrain disruption (can affect one or both pupils)- anoxia- hypothermia- anticholinergics- severe barbituate overdose
4
Q
pupil size in coma:- two dilated, nonreactive pupils- examples
A
- anoxia- hypothermia- anticholinergics- severe barbituate overdose
5
Q
pupil size in coma:- two dilated, nonreactive pupils- examples
A
- opiates- pontine destruction
6
Q
what is a seizure?
A
- paroxysmal electrical discharges of brain that cause LOC- alteration of perception or impairment of psychic function- convulsive movements- disturbance of sensation- or some combination thereof
7
Q
what is epilepsy?
A
recurrent, unprovoked seizures
8
Q
what is status epilepticus?
A
- prolonged or repetitive seizures- life-threatening
9
Q
what are triggers for seizures in susceptible individuals?
A
- alcohol- cocaine- intense emotions- strobe lighting- loud music- stress- menstruation- lack of sleep
10
Q
seizures are categorized into what 2 categories?
A
- GENERALIZED- FOCAL
11
Q
focal seizures involve how many sides of the brain, and motor activity is noted on how many sides?
A
- 1 hemisphere- usually 1
12
Q
generalized seizures involve how many sides of the brain, and motor activity is noted on how many sides?
A
- both hemispheres- usually both, but not necessarily
13
Q
focal (partial) seizures are further classified into what categories?
A
- simple partial: no LOC2. complex partial: LOC3. partial w/ secondary generalization
14
Q
generalized seizures are further classified into what categories?
A
- nonconvulsive: absence seizure2. convulsive:2a. myoclonic2b. clonic2c. tonic-clonic2d. atonic
15
Q
focal seizures are commonly d/t what?
A
focal brain lesions
16
Q
primary generalized seizures are more typically d/t what?
A
genetics
17
Q
if PNES (psychogenic nonepileptic seizures) are suspected or when the events do not respond to tx and the dx is not clear, what should be ordered?
A
video EEG monitoring
18
Q
what percentage of pts w/ PNES (psychogenic nonepileptic seizures) also have epilepsy?
A
20%
19
Q
what is an aura?
A
perceptual disturbance that may precede a FOCAL seizure
20
Q
auras may precede what type of seizure?
A
FOCAL seizures
21
Q
auras do NOT occur w/?
A
PRIMARY generalized seizures
22
Q
how can auras manifest?
A
- SENSES- MOTOR
23
Q
auras are thought to be produced by?
A
EARLY seizure activity
24
Q
describe generalized tonic-clonic seizures
A
- involve both hemispheres- BILATERAL motor involvement- LOC- pronounced postictal period
25
describe absence seizures
- nonconvulsive- no aura- no postictal symptoms- sudden interruption of consciousness- can be induced by HYPERVENTILATING- 3-per-second spike and wave pattern on EEG
26
what number of children outgrow absence seizures?
2/3
27
describe focal (aka simple partial) seizures
- no LOC- symptoms depend on affected region of cortex
28
describe focal seizures w/ diminished consciousness (aka complex partial): temporal lobe type
- aura may hallucination- altered behavior/consciousness- amnesic- automatisms: lip-smacking, chewing or swallowing movements, salivation, fumbling of hands, shuffling of feet
29
definition of status epilepticus
- seizure lasting > 30 minutes- 2 or more seizures WITHOUT regaining consciousness in between
30
when should you be aggressive when treating seizures and use abortive therapy?
when seizure lasts 5 minutes or more
31
what are possible causes of status epilepticus?
- stroke- alcohol- drugs- stopping or changing AEM's- hypoxia- CNS infection- metabolic causes- tumor- trauma
32
seizure management: history
- alcohol use- drug use- head injury- sleep deprivation- diabetes- thyroid or parathyroid surgery
33
seizure management: laboratory tests
- glucose- Na+- Ca++- Mg++- transaminases- BUN- LP for VDRL if meningeal sxs
34
seizure management: best neuroimaging test
MRI (to r/o structual abnormality)
35
seizure management: can confirm dx of seizures and localize the origin
EEG
36
can a NORMAL EEG exclude the dx of epilepsy?
NEVER
37
after initial seizure, RISK OF RECURRENCE increases w/ the following:
- abnormal EEG- h/o prior neurological injury- family h/o seizures- 1st seizure is a FOCAL seizure- MRI shows abnormality
38
ACUTE TX OF SEIZURES
IV benzos
39
typical tx of status epilepticus in adults
1. thiamine, and 1 amp of D50 if blood glucose is low2. LORAZEPAM x 2 doses3. loading dose of PHENYTOIN/fosphenytoin
40
tx of status epilepticus if pt continues seizing after initial tx
1. 3rd dose of lorazepam2. maximize phenytoin dose3. proceed to barbiturate or propofol4. +/- ET intubation and ICU care (generally needed if first 2 doses and dose of phenytoin don't work)
41
mainstay of chronic tx of seizures
AEDs, w/ monotherapy as the preferred goal
42
PRIMARY DRUG for: focal
carbamazepine
43
advantage of carbamazepine
toxicity is UNcommon
44
disadvantages (adverse effects) of carbamazepine
- hyponatremia- leukopenia- thrombocytopenia- aplastic anemia- hepatotoxicity- teratogenic- liver inducer; reduces OCP efficacy
45
PRIMARY DRUG for: generalized tonic-clonic
valproic acid
46
advantages of valproic acid
- wide spectrum- good efficacy- IV form available
47
disadvantages (adverse effects) of valproic acid
- GI side effects- can rarely cause BM suppression and hepatotoxicity/liver failure- teratogenic (neural tube defects)- tremor- weight gain- hair loss
48
PRIMARY DRUG for: absence (only)
ethosuximide
49
disadvantage (adverse effects) of ethosuximide
BM suppression (rare)
50
tx for absence (short-term adjunctive use only)
clonazepam
51
disadvantages (adverse effects) of clonazepam
loses efficacy
52
advantages of levetiracetam
- well tolerated in elderly- safe in Asian pts w/ HLA-B*1502 (increased risk of SJS)- renally excreted so no interaction w/ levels of other AEDs
53
disadvantages (adverse effects) of levetiracetam
- depression- fatigue- irritability- increased infections
54
advantages of gabapentin
- one AED w/ NO significant drug interactions- renally excreted so useful in pts w/ liver disease
55
disadvantages (adverse effects) of gabapentin
- ataxia- amnesia- limited efficacy
56
advantages of lamotrigine
- wide spectrum- good efficacy- well tolerated in elderly
57
disadvantage (adverse effects) of lamotrigine
severe rash and SJS w/ rapid titration
58
last choice tx for focal siezures
phenobarbital
59
disadvantages (adverse effects) of phenobarbital
- sedation in adults- hyperactivity in children- teratogenic- liver inducer; reduces OCP efficacy- DECREASES levels of other AEDs
60
advantages of topiramate
- weight loss- headache ppx if present
61
disadvantages (adverse effects) of topiramate
- kidney stones- increased glaucoma- weight loss- paresthesias- cognitive dysfunction- teratogenic- reduces OCP efficacy
62
which AEDs can be used to tx focal seizures?
ALMOST ALL AEDs, EXCEPT ethosuximide
63
tx for generalized seizures (tonic-clonic)
- TOPIRAMATE- LAMOTRIGINE- VALPROATE- levetiracetam- felbamate- funinamide- zonisamide
64
tx for generalized seizures (absence)
- lamotrigine- ethosuximide- valproic acid
65
when can you STOP AEDs?
individualized for each pt
66
tx options for INTRACTABLE EPILEPSY
- resective surgery- vagus nerve stimulation- ketogenic diet (works well in children)
67
which AEDs reduce OCP efficacy? (6)
- phenytoin- phenobarbital- carbamazepine- lamotrigine- oxcarbazepine- topiramate (higher doses)
68
uncontrolled seizures during pregnancy can cause
- placental abruption- early labor- premature delivery
69
AEDs are still used in pregnancy bc the risk of complications from uncontrolled seizures is even GREATER than
risk of teratogenicity
70
tx strategy for seizures during pregnancy
- control seizures as much as possible- MONOTHERAPY- LOWEST DOSE possible
71
MOST LIKELY AED to cause NEURAL TUBE defects
valproic acid
72
teratogenic risk of AEDs is DECREASED by
FOLIC ACID
73
should prophylactic VITAMIN K be given during the last MONTH of pregnancy in pts on AEDs bc of reports of increased bleeding?
no, currently not enough evidence
74
what is the definition of dementia?what is the definition of mild cognitive impairment?what is the clinical triad in NPH?how is AD diagnosed?1st line tx for AD
- chronic cognitive decline w/ or w/o behavioral impairment- PROGRESSIVE- INTERFERES w/ normal daily functioning- NOT d/t DELIRIUM or PSYCHIATRIC D/O
75
dementia is diagnosed ONLY after completion of the following 3 tasks
1. thorough H&P2. neuropsychiatric testing3. objective cognitive assessment (MMSE or MOCA)
76
how many abnormalities needed to diagnose dementia?
2 OR MORE out of 5 DOMAINS
77
which 5 domains may be impaired in pts w/ dementia?
1. memory2. executive function3. perception4. language5. behavior
78
typical feature of advanced dementia
PSYCHOSIS refractory to treatment
79
what is the dx?- when only ONE OR MORE of the DOMAINS is in decline- impairment does NOT significantly impact daily functioning
mild cognitive impairment (MCI)
80
what are the 2 types of mild cognitive impairment (MCI), and which is more common?
- amnestic and nonamnestic- AMNESTIC
81
at what rate does mild cognitive impairment (MCI) progress to dementia?
5-10% per year
82
what are reversible causes of dementia that need to be r/o when evaluating dementia?
- medications- vitamin B12- hypothyroidism- chronic subdural hematomas- normal pressure hydrocephalus- tumors- infection/inflammation (AIDS, neurosyphilis, neurosarcoidosis, chronic meningitis, lupus cerebritis, vasculitis, autoimmune encephalopathy (such as Hashimoto encephalopathy))- heavy metal poisoning (arsenic, mercury, lead)
83
- enlargement of ventricles w/o obstruction of aqueduct (ie "COMMUNICATING HYDROCEPHALUS)- NO cerebral atrophy
normal pressure hydrocephalus (NPH)
84
NPH often occurs after...
- head TRAUMA- MENINGITITS- SUBARACHNOID HEMORRHAGE
85
- NORMAL intracranial pressure- NO papilledema- NO headache
normal pressure hydrocephalus (NPH)
86
classic triad of normal pressure hydrocephalus (NPH)
1. gradually worsening dementia2. gait apraxia; "magnetic gait"3. urinary incontinence
87
- must differentiate this from NPH- more common in pts w/ HTN or DM- can present w/ the SAME clinical TRIAD as NPH
diffuse white matter disease
88
treatment for NPH
VENTRICULOPERITONEAL or VENTRICULOATRIAL SHUNT
89
MC of dementia AFTER 60 YEARS OF AGE
Alzheimer disease (AD)
90
diagnosis for Alzheimer disease (AD)
- INSIDIOUS- PROGRESSIVE- 2 or more impaired domains (memory, executive functioning, perception, language, behavior) causing SIGNIFICANT IMPAIRMENT in normal daily functioning
91
do NOT use these for definitive dx of Alzheimer disease (AD)
- MRI- PET scan- CSF tau measurements
92
why should MRI, PET scan, and CSF tau measurements NOT be used for dx of Alzheimer disease (AD)?
NOT SPECIFIC ENOUGH
93
when should a dx of Alzheimer disease (AD) NOT be made?
- h/o cerebrovascular disease- clinical features of frontotemporal dementia- clinical features of dementia w/ Lewy bodies- evidence of another psych or neuro illness- takes meds that cause cognitive impairment
94
what are the main diagnoses to consider in elderly pt w/ dementia w/o movement d/o?
- Alzheimer dz- VASCULAR dementia- MIXED dementia (w/ both neurodegenerative and vascular components)
95
1st line tx for Alzheimer dz
- CHOLINESTERASE INHIBITORS (CIs)- donepezil (Aricept)- rivastigmine (Exelon)- galantamine (Razadyne)
96
what ADDITIVE drug tx can be used for Alzheimer dz?
memantine (Namenda)(N-methyl-D-aspartate receptor antagonist)
97
what is better for tx of Alzheimer dz, especially advanced AD?
COMBINATION of CI and memantine
98
can you use cholinesterase inhibitors and memantine for MCI?
NO
99
what are the cholinergic sxs d/t adverse effects of cholinesterase inhibitors?
- anorexia- nausea- diarrhea- bradycardia
100
which atypical antipsychotics can used to tx agitation, insomnia, delusions, aggression, and wandering, but can INCREASE MORTALITY?
- olanzapine- quetiapine- risperidone- clozapine
101
what are the 2 general categories for dementia caused by cerebrovascular dz?
1. MULTI-INFARCT dementia2. DIFFUSE WHITE MATTER disease (Binswanger dz)
102
characteristics of multi-infarct dementia
- d/t several strokes (large or small) in different brain regions- have prominent motor, reflex, visual, and gait abnormalities- do NOT have difficulty NAMING objects- ABRUPT onset- STEPWISE deterioration of mental function- different from ALZHEIMER'S which is SLOW and steady
103
MCC of diffuse white matter dz
chronic HTN
104
similar in presentation and course to Alzheimer dz
frontotemporal dementia (previously Pick dz)
105
difference between frontotemporal dementia and Alzheimer dz
- MORE RAPID- DISINHIBITION- LANGUAGE DEFICITS- onset in 5th to 6th decade of life- males > females
106
CT or MRI scan results of ALzheimer pt
diffuse brain atrophy
107
CT or MRI scan results of frontotemporal dementia pt
MORE FOCAL ATROPHY of frontal and temporal lobes
108
only sure way to differentiate between Alzheimer and frontotemporal dementia pts
histologically at autopsy
109
one of the very rare PRION dzs
Creutzfeldt-Jakob disease (CJD)
110
how is Creutzfeldt-Jakob disease (CJD) subdivided?
- SPORADIC (most typical, 95%)- FAMILIAL (about 5%)- IATROGENIC- VARIANT
111
when does sCJD (sporadic Creutzfeldt-Jakob disease) usually present, and what causes it?
- 55-65 yoa- we have no idea!
112
when you see CJD in younger pts, think of
iCJD or vCJD
113
what is believed to be the cause of vCJD?
prion causing "MAD COW DISEASE" (bovine spongiform encephalopathy)
114
what causes iCJD?
- receipt of infected human tissues (dural grafts, corneal transplant, or liver transplant)- receipt of infected hormones (eg GH, or gonadotropins)- exposure to contaminated surgical instruments)
115
characteristics of Creutzfeldt-Jakob disease (CJD)
- RAPIDLY PROGRESSIVE dementia (weeks, not years)- startle MYOCLONUS (startle to loud noises)
116
- changes in behavior- changes in emotional response- changes in intellectual function- ataxia- visual distortions- confusion- hallucinations- delusions- agitation- dementia- muteness
Creutzfeldt-Jakob disease (CJD)
117
younger pts w/ vCJD have dementia w/ what predominant features?
PSYCHOTIC
118
gold standard for diagnosing Creutzfeldt-Jakob disease (CJD)
brain BIOPSY
119
other supportive studies for diagnosing Creutzfeldt-Jakob disease (CJD)
- MRI- EEG- 14-3-3 PROTEIN in CSF
120
mortality rate of Creutzfeldt-Jakob disease (CJD)
fatal in < 1 yr in > 90% of pts
121
treatment for Creutzfeldt-Jakob disease (CJD)
none
122
cause of Parkinson dz (PD)
loss of dopaminergic neurons in substantia nigra
123
what percentage of Parkinson dz (PD) develop dementia?
80%
124
dementia in Parkinson dz (PD) pts primarily affects what?
- EXECUTIVE FUNCTIONS- ATTENTION
125
when dementia PRECEDES or develops w/i 1 year after onset of motor dysfunction, it is referred to as
DEMENTIA W/ LEWY BODIES (DLB)
126
clinical features of dementia w/ Lewy bodies (DLB), besides dementia
- spontaneous motor features of parkinsonism- recurrent, vivid visual hallucinations- prominent fluctuations of attention and cognition
127
which med spares D2 dopamine receptor and can be helpful in PDD and DLB?
CLOZAPINE
128
which meds are not good for dementia w/ Lewy bodies (DLB)?
older antipsychotic drugs; haloperidol and chlorpromazine
129
which meds are under FDA SAFETY ADVISORY bc they are associated w/ an INCREASED RISK OF DEATH in elderly pts w/ dementia, especially DLB?
antipsychotic drugs
130
- dementia- usually occurs in 6th decade of life- GAZE PALSY- abrupt falls
progressive supranuclear palsy (PSP)
131
- DEMENTIA- MOVEMENT DISORDER- autosomal dominant w/ complete penetrance
Huntington disease
132
what gene is responsible for Huntington disease (HD)?
HTT gene on chromosome 4p
133
when does Huntington disease (HD) occur?
LATE 30s
134
what are sxs of Huntington disease (HD)?
- dementia- CHOREA- psychiatric disturbances (personality changes, depression, and PSYCHOSIS)
135
dx for Huntington disease (HD)
- positive family hx- clinical features- genetic testing for HTT gene
136
imaging finding in Huntington disease (HD)
caudate nuclei atrophy ("boxcar" ventricles)
137
cure for Huntington disease (HD)?
none, FATAL
138
tx for MILD CHOREA in Huntington disease (HD)
tetrabenazine
139
adverse effects of tetrabenzapine
- depression- sedation- bradykinesia
140
MCC of dementia in younger pts
AIDS
141
- cognitive impairment- movement d/o- depression- HIV
HIV-associated dementia (HAD)
142
what is "pseudodementia?"
significant cognitive dysfunction in pts w/ MAJOR DEPRESSION
143
what is one differentiating feature seen in moderate or advanced dementia, but NOT pseudodementia?
FRONTAL LOBE release signs (grasp, suck, rooting, and palmomental reflexes)
144
is commonly poor in depression d/t attentional dysfunction, but good in dementia pts
immediate recall
145
what is delirium?
- acute, often transient, altered mental status- typically occurs w/i hours to days
146
in whom and where is delirium most commonly seen?
- hospitalized elderly pts- ICU pts
147
dx delirium
- clinical- decreased attention span- varying states of confusion
148
most crucial aspects in dx type and etiology of a headache
history and physical
149
what history must be determined when dx a headache?
- QUALITY of pain (dull, sharp, throbbing, constant)- LOCATION- DURATION- EXACERBATING factors- ALLEVIATING factors- associated sxs
150
how are headaches classified?
primary or secondary
151
what are the primary types of headache? (5)
1. migraine2. tension-type headache3. cluster headache4. other trigeminal autonomic cephalgias5. other headaches
152
what are the characteristics of primary headache?
- chronic- recurrent- w/o signs of neurologic dz
153
what are the secondary types of headache? (10)
1. d/t hemorrhage2. head/neck trauma3. benign intracranial HTN4. brain tumors5. cranial/cervical vascular d/o6. substance abuse/withdrawal7. infection8. homeostasis d/o9. facial pain10. psychiatric d/o
154
what hemorrhage can cause severe headache?
subarachnoid
155
what are some examples of cranial/cervical vascular d/o that can cause headache?
- carotid dissection- sinus venous thrombosis- giant cell arteritis
156
what are some examples of substances or their withdrawal that can cause headache?
- nitrates- EtOH- caffeine
157
what are some examples of infection that can cause headache?
- meningitis- encephalitis
158
what are some examples of homeostasis d/o that can cause headache?
- HTN- hyperviscosity
159
what are some examples of facial pain that can cause headache?
- cranium- neck- eyes- sinuses- teeth- trigeminal neuralgia- herpes zoster
160
- typical- largely familial d/o- periodic- often U/L- pulsatile (throbbing) pain- begin in childhood, adolescence, or early adulthood, and diminish in frequency w/ age
migraine headache
161
definition of EPISODIC migraine headache
< 15 headaches/month
162
definition of CHRONIC migraine headache
> 15 headaches/month x 3 months
163
triggers for migraine headaches
- emotional stress- foods (eg chocolate, AGED CHEESE, foods rich in tyramine- alcohol- menstruation- glare- strong sensory stimuli (eg perfume)- rapid changes in barometric pressure
164
what % of migraine headaches have an aura?
25%
165
most common visual sxs in migraine w/ AURA
- sparkling lights (scintillating scotomata)- jagged zigzag lines (fortification spectra)
166
how long do migraine auras last?
5-60 minutes
167
what do longer than usual migraine auras represent?
complicated migraine or concern for stroke
168
how much more typical is a migraine withOUT aura than one w/?
5x
169
- visual phenomena that occupy BOTH visual fields (temporary cortical blindness)- vertigo- dysarthria- INCOORDINATION of limbs- diplopia- tingling- headache that affects BRAINSTEM
basilar migraine
170
- migraine w/o headache- abnormal transient neurologic dysfunction
acephalic migraine
171
multiple or virtually continuous headaches w/ scalp tenderness, > 72 hours
status migrainosus
172
diagnosis for migraine headache
HISTORY
173
if pt presents w/ typical migraine sxs, next step?
FIRST give TREATMENT TRIAL
174
initial study for migraine w/ atypical sxs, HA pattern change, seizure, or focal neurologic sxs
CTH w/ and w/o contrast
175
what is ACUTE tx for migraine headache?
any tx given WITHIN FIRST HOUR of HA
176
what are some effective txs for acute migraine?
- acetaminophen- aspirin- NSAIDs
177
1st line treatment for migraine
TRIPTANS(sumaTRIPTAN, zolmiTRIPTAN, rizaTRIPTAN, naraTRIPTAN, almoTRIPTAN, eleTRIPTAN, frovaTRIPTAN)
178
which triptan works the fastest?
rizaTRIPTAN
179
which triptan has 3 methods of delivery, injection, intranasal, and PO?
sumaTRIPTAN
180
which tx combination for migraine HA works synergistically and better than taking either as monotherapy?
sumaTRIPTAN and naproxen
181
when are triptans CI bc of r/o inducing ischemia?
- complicated or basilar migraines- CHD or Prinzmetal angina- h/o stroke- uncontrolled BP- pregnancy
182
which 2 medications are effective for termination of migraine in pts who present to the ER w/ VOMITING?
- PROCHLORPERAZINE- METOCLOPRAMIDE
183
if pts take migraine headache medications too fequently, what can happen?
medication overuse headaches
184
American Heart Association/American Stroke Association 2014 Guideline for Prevention of Stroke in Women recommend PROPHYLAXIS for women w/ frequent migraines w/ aura if, what?
- GREATER THAN 55 YOA, especially if, taking OCPs
185
what are the major categories of migraine prophylaxis?
- BB
- TCA
- AED
- CCB
- ACEI/ARB
- NSAID
- botulinum toxin
186
which BBs are FDA-approved for migraine prophylaxis tx?
propranolol and timolol
187
when are propranolol and timolol NOT recommended for migraine prophylaxis tx?
- GREATER THAN 60 YOA
| - and/or SMOKERS
188
distinct headache syndrome that responds to O2 tx
cluster headaches
189
how often do cluster headaches usually occur?
several times/day for a few weeks
190
cluster headaches are more common in which sex?
MALES (5:1)
191
what's a common trigger of cluster headaches?
ALCOHOL in 70% of pts
192
cluster headaches description
- UNIlateral
- severe
- ICE PICK or HOT POKER
- PERI- or RETRO-ORBITAL
193
when do cluster headaches usually occur?
night 1-2 hours after sleep onset, or several times throughout night
194
what are the associated vasomotor phenomena of cluster headaches?
IPSIlateral blocked nostril, rhinorrhea, lacrimation, miosis, flush, and edema of that cheek
195
best acute treatment for cluster headaches?
OXYGEN (6 L/min x 15 minutes) is commonly RAPIDLY ABORTIVE
196
what tx can be combined w/ O2 for acute tx for cluster headaches?
SC or IN triptans
197
DOC for cluster headache prophylaxis after 1st episode
verapamil (PO up to 480mg)
198
adverse effects of verapamil if dose higher than 240mg
- bradycardia
| - heart block
199
MC variety of headache
tension headache
200
tension headache characteristics
- pain that is chronic
- B/L
- constant
- nonthrobbing
- "SQUEEZING"
- no migraine/cluster headache features
201
duration of tension headaches?
can be present throughout the day for long periods of time
202
1/3 of pts w/ chronic tension headaches have sxs of?
depression
203
treatment for acute tension headaches
- acetaminophen
| - NSAIDs
204
when should you consider PREVENTION medication for tension headaches?
if attacks occur > 2 days per week
