2018 Neurology 4% Flashcards
Migraine
F>M
Q few weeks
1/2 hr onset
Lasts hours to days
Frontal/temporal one or both sides
Throbbing
n/v/aura/photophobia, AM menarch, menses, weahter, stress, worse with movement
Tx: Tylenol/NSAID/ASA -> Sumatriptan->chloropromazine/metochlopramide
Prevention: BB, TCA, Vit B2 (riboflavin), CoQ 10, Topiramate, Botox
Cluster h/a
M>F
1-2/day
onset 2-15min
lasts 1/2 hr-2hrs
Orbital/one side
Excruciating
Rhinorrhea, ipsilateral Horner’s, Unilateral lacrimation
Tx: 100 OXYGEN, intranasal lidocaine, sumatriptan
Prevention: Verapamil, valproate, gabapentin
Tension h/a
F>M How often? Variable Onset Variable how long 1/2hr to 7 days Where: diffuse Non-throbbing Band like Tx: analgesics Prevention: BB, TCA
25yo F p/w chronic h/a x years noticed from puberty, mainly with waking up, several hours every few weeks, throbbing aw nausea and vom no auras - several tylenol and motrin didn’t help - acute pain would respond to….
Sumatriptan
25yo F with FLASHES of light moving across eyes for a few minutes wiht loss of visio nin one eye - left homonymous defect -normal after 45 min
Dx: Migraine
Young woman co wk in R arm and leg - PMHx migraines - feels better after couple hours - carotid US, MRI brain and TEE normal dx?
Migraines
DO NOT USE TRIPTANS with CAD or vasculitides
52yo M p/w moderately severe befrontal throbbing ha - aw nausea - had h/a for past few years - normal temp - BP 150/90, fundoscopy normla neck supple, pupils reactive no focal neur effects histor significant for CAD wtd?
NSAID with prochloroperazine
Acute migrain with nausea and vomiting fastest relief?
SQ Sumitriptan
Severe acute migraine not responding to sumatriptan or lasting >72hrs
IV dopamin antagonist (prochlorperazine.metoclopramide) + IV diphenyhydramine (prevent acute dystonic rxn)
Severe acute migrain x more than 72hrs - last sumatriptan >24hrs ago with little response - >
parental dihydroergotamine
Pregnancy with migraine h/ once a week
tylenol
Pregnancy with migraine h/a no response to Tylenol
Metoclopramide or Chloroproazine or ondeansetron
Migraine ppx for h/a’s how often?
2 times per week
PPX for migraine <15x/month
BB, amitriptyline, topiramate, sodium valproate
PPx for migraine >15/month
Topriamate-> botox
PPX migraines with asthma
Divalproex sodium, topiramate (no BB CI)
Prevention of menstrual h/a
mefenamic acid (Ponstel) … 2 days prior and up to end of menstruation
Migraine with Aura
OCP contraindicated!! Can cause DVT in brain. Progesterone only IUD.
Pt with migrain h/a takes NSAIDs and tylenol daily. now not working wth h/a daily from morning to evening
Analgesic induced h/a
d/c all analgesics
42yo F chronic non-throbbing h/a worse at end of day - band like around neck
Tension h/a
35yo F c/o excruciating Ice pick like retro-orbital h/a - h/o rhinorrhea, lacrimation, ipsilateral horner’s
Cluster h/a
Pt with recurrent h/a >5-6/day, lasting 15-20minutes, unilateral and retrooribtal
Chronic paroxysmal hemicrania
Tx: Indomethacin
32yo obese woman BMI>30 with daily h/a - horizontal diplopia - blurring of optic disc margins - wtd next?
CT scan (r/o) DVT in brain. IF neg --> MRV, if neg --> spinal tap (with incr pressure) Idiopathic Itracranial HTn (Pseudotumor cerebri)
Tx: Acetazolamide, lumboperitoneal shunt
Etio: obesity, Vit A toxicity, tetracycline, steroids, contraceptives, nitrofurantoin, isotretinoin, minocycline, danazol, tamoxifen, levothyroxine
Comoplications of pseduotumor cerebri
Peripheral visual field loss-> central visual field loss