PDF - HA

Question 1

How does brain feel pain?

Answer 1

It does not, it is the effect of stretching and changes in nerves and vessels
- Tension of muscles and inflammation of adjacent mucosal structures also can cause this

Question 2

What happens to arteries in migraine?

Answer 2

They dilate

• This is a result of the disease, not a cause of it
• Cause is neuronal dysfunction

Question 3

Who at most risk for migraine?

Answer 3

Women with family history

- Often arise at puberty with menstruation being a trigger

Question 4

What causes and aura?

Answer 4

Wave a depolarization over certain parts of the cortex

- Visual is form depolarization of visual occipital cortex

Question 5

What is a scotoma?

Answer 5

Patch of blindness often seen in migraine aura

Question 6

Laterality migraine?

Answer 6

Starts unilateral, can generalize but often does not

- Described as throbbing or pounding

Question 7

Duration migraine?

Answer 7

Hours - 2 days

- Malaise and hangover can continue after

Question 8

How does migraine start?

Answer 8

Spreading wave of cerebral depolarization, which is often, but does not have to have a trigger

Question 9

What happens when depolarization hits trigeminal?

Answer 9

Nausea, vomiting, and photophobia.

Question 10

What to do if there is first migraine without an aura?

Answer 10

MRI

Question 11

When to image MRI?

Answer 11

1. If appears later in life
2. If first and no aura
3. If neuro deficit
4. Cognitive change
5. Seizure

Question 12

Med or aborting migraine?

Answer 12

Triptans which come in nasal, oral, IM

Question 13

What is Dihydroergotamine?

Answer 13

Drug helpful in aborting severe migraine, delivered by

injection or nasal spray

Question 14

Prophylactic migraine meds?

Answer 14

1. Propranolol
2. Verapamil
3. Amitriptyline,
4. Valproate / gabapentin / topiramate

Question 15

How are tension HAs described?

Answer 15

Pressure or band like feeling around head w/o warning signs or aura

Question 16

Med never to use for HA?

Answer 16

Butalbital

Question 17

What is traction HA? Rx?

Answer 17

Post LP from leaking of CSF
- Positional and relieved with lying flat
Rx: injection of patient’s blood into epidural space produces “epidural blood patch” sealing dural leak

Question 18

Rx Pseudotumor Cerebri?

Answer 18

1. Weight loss
2. Acetazolamide - medication to inhibit CSF production
3. Shunt
4. Repeated LPs

Question 19

Presentation pseudotumor?

Answer 19

1. Obese
2. Similar to migraine
3. Papilledema bilateral
4. Brain scan with no lesion
5. LP - normal CSF with high pressure giving relief

Question 20

What causes papilledema in pseudotumor?

Answer 20

Increased ICP from impaired CSF reabsorption and can lead to blindness if not diagnosed and treated

Question 21

Lab in temporal arteritis?

Answer 21

Very high ESR

Question 22

Rx temporal arteritis?

Answer 22

Prompt corticosteroids to prevent blindness from

involvement of ophthalmic arteries