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Flashcards in Neurology IV Deck (34):
1

Headache disorders:

primary and secondary
tension-type
cluster
migraine

2

lifestyle causes of secondary headache disorders:

dehydration
poor nutrition
sleep deprivation
lack of exercise
stress

3

Common causes of secondary headache disorder:

lifestyle
hypoxia
sinusitis
TMJ dysfunction
hypothyroidism
diabetes
lupus

4

Most common type of primary headache in adults:

Tension-type headache

5

sxs of tension-type headaches:

constant pressure
usually bilateral
occipital, frontal, or both
mild to moderate, occasionally severe
usually precipitated by stress or hunger
muscle tenderness (although muscle relaxants are not helpful)

6

tension-type headache tx:

OTC pain medications
triptans
opiates not indicated

7

tension-type treatment prophylactic tx:

lifestyle changes
stress management
warm or cool packs
tricyclic/tetracyclic antidepressants
SNRIs and anticonvulsants

8

A cluster headache is:

repeated episodes of excruciatingly severe, unilateral headache lasting 15 minutes to 3 hours

9

cluster headaches may recur:

1-8 times per day for a week to several months, then go into remission for weeks, months, or years

10

sxs of cluster headaches:

*severe unilateral pain accompanied by ipsilateral ptosis, miosis, conjunctival injection, lacrimation, and rhinorrhea.
*Some patients experience facial flushing, edema, or diaphoresis
*Attacks often awaken pt from sleep

11

Cluster headache triggers:

EtOH use and nitrates.

12

PET scans of individuals who are suffering from a cluster headache attack reveal:

increased metabolic activity in the hypothalamus

13

cluster headache tx:

*OTC pain meds and opioids are not effective.
*100% O2 in a high-flow non-rebreather mask may be helpful
*Triptans are usually helpful
*Melatonin, lithium, and anticonvulsants (TPM, VPA, GBP) may be useful
*Low dose LSD and psilocybin may be helpful

14

characteristics of those who are likely to suffer from cluster headaches

Men > women (5:1)
blue or hazel eyes
rugged, "lionized" facial features
heavy smokers/drinkers
onset usually 20-50 yrs

15

Migraine sxs:

recurrent episodes of moderate to severe headache with autonomic sxs. typically unilateral, throbbing pressure-type pain lasting 1 hour to 3 days

16

Migraine more common in males or females?

migraines are more common in males before puberty and then shifts during adolescents.

17

Autonomic sxs of migraine

pallor, sunken eyes
nausea, vomiting
photophobia, phonophobia
lightheadedness, vertigo

18

Stages of migraine:

prodrome (hours to days before)
aura (immediately preceding)
pain/headache phase
postdrome (hours to days after)

19

Migraine prodromes:

irritability, change in mood (depression/euphoria), craving for certain foods, neck pain, constipation/diarrhea, sensitivity to smell or noise

20

Migraine auras:

(zigzagging lines)
numbness, tingling, pins-&-needles
hemianopsia

21

Migraine postdromes:

lingering ache in the area where headache was
feeling tired
feeling "hungover"
feeling weak or depressed
some feel euphoric

22

Direct cause of migraine pain?

most likely vasodilation

23

cause of migraine aura?

most likely caused by spreading cortical depression or vasospasm

24

migraine diagnosis

diagnosed by history

25

types of migraines:

migraine with aura (classic migraine)
migraine without aura (common migraine)
chronic migraine/converted migraine
migraine variants

26

migraine variants

ophthalmoplegic migraine
hemiplegic migraine
confusional migraine

27

Childhood periodic syndromes

abdominal migraine
cyclic vomiting syndrome

28

Abdominal migraine characterized by?

abdominal pain, with or without headache

29

cyclic vomiting syndrome characterized by?

bouts of severe nausea and vomiting that last for hours to days, alternating with sx-free intervals.

30

preventative lifestyle changes fro migraines:

hydration, nutrition, sleep hygiene and sufficient hours of sleep, aerobic exercise, robust stress management

31

Noted migraine triggers to avoid:

MSG, nitrites, aspartame, aged cheese (tyramine), fluorescent lighting, EtOH (especially red wine), caffeine

32

preventative therapies for migraines:

beta-blockers, Ca2+, ACE inhibitors, tricyclic antidepressants, SNRIs, anticonvulsants (VPA/TPM), repetitive transcranial magnetic stimulation (rTMS), high doses of B2, Magnesium supplements, CoQ-10 can reduce frequency, and progesterone based contraception can be helpful in some women

33

Acute migraine therapies:

APAP, NSAIDs, triptans, ergot, antiemetic meds, sedating antihistamines. Opiates not indicated.

34

Migraines with aura doubles the risk of:

Ischemic stroke. Smoking exacerbates this risk.