3 Headache, pt 2 Flashcards

1
Q

The most common non-life-threatening headache in the ED

A

Migraine

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2
Q

Features of Migraine

A

Pulsatile, throbbing
Photosensitivity, phonosensitivity
Lasts hOurs (4-72 hours)
Unilateral
Nausea, vomiting
Debilitating, worse with exertion
4/5 has positive likelihood ratio of 24 for migraine

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3
Q

Chronic migraine is defined as

A

5 or more migraine headache days per month over the past 3 months

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4
Q

First-line abortive therapy for migraine at home

A

Triptans

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5
Q

ED treatment of migraine

A

Dopamine receptor antagonist (metoclopramide, droperidol)
+ NSAIDs
Steroids may be useful to reduce the risk for headache recurrence after ED discharge

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6
Q

Opiates in migraine

A

Opiates and barbiturate-containing compounds should not be used routinely for abortive migraine thearpy unless other standard treatments fail

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7
Q

Remarks on cluster headache

A

severe (excruciating)
unilateral
lasts 15-180 mins (brief and self-limited)
Circardian / circannual

Can mimic dental pain
More common in men

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8
Q

distinguishing feature of cluster headache

A

the need for the patient to “pace”

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9
Q

Treatment of cluster headache

A

100% oxygen administered at 12L/min for 15 mins through NRM
Sumatriptan, 6 mg SC

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10
Q

Presentation of PRES

A

Posterior Reversible Encephalopathy Syndrome
severe headache,
visual changes,
seizures,
encephalopathy
marked hypertension

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11
Q

PRES is most common in

A

Patients undergoing active treatment with immune-suppresing or -modulating medications
or chemotheraptuic agents,
and in end-stage renal disease

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12
Q

Imaging findings in PRES

A

MRI: symmetrical vasogenic edema in the occipital area of the brain

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13
Q

Treatment of PRES

A

BP control and supportive care

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14
Q

This condition can mimic subarachnoid hemorrhage

A

RCVS
Reversible cerebral vasoconstriction syndrome
characterized by the occurrence of 1 or more “thunderclap” headache
should be considered only when the evaluation for SAH has proven negative

also mimic SAH: CVT, carotid artery dissection

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15
Q

Diagnosis of RCVS

A
  1. The clinical presentation of thunderclap headache without evidence of SAH should be the main prompt to making this diagnosis or consulting with a neurologist
  2. Head CT is most commonly normal
  3. the key diagnostic feature (multiople areas of cerebral vasoconstriction on MRA) is most commonly found on follow-up angiography between 2 and 3 weeks after symptom onset
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16
Q

Remarks on occipital neuralgia

A

paroxysms of pain at the back of the head
described as stabbing or electric shock-like

17
Q

Treatment in occipital neuralgia

A

occipital nerve block typically results in marked improvement of symptoms
- results can persist for weeks after injection
- both diagnostic and therapeutic
- can be performed with easy in any setting and requires minimal expertise

18
Q

remarks on idiopathic intracranial hypertension

A
  1. aka pseudotumor cerebri
  2. most common in obese women
  3. if untreated, can lead to permanent vsual impairment
19
Q

diagnostic criteria of idiopathic intracranial hypertension

A

papilledema
otherwise normal neurologic exam
elevated opening pressure on LP (>25 cm H2O in adults, >28 cm H2O in children)
normal CSF composition
normal imaging

20
Q

treatment of idiopathic intracranial hypertension

A

Focused on preservation of vision
LP may provide temporary relief of symptoms (target pressure of 15-20 cm H2O)
In general, removal of 1 mL of CSF will lower the CSF pressure by about 1 cm H2O

21
Q

Detecting increased ICP

A

US of the optic nerve sheath diameteter
<5 mm is normal
>6 mm is abnormal
5-6 mm is controversion

22
Q

Clinical feature of intracranial hypotension

A

AKA low-pressure headache
Headache that increases in severity with upright posture but improves or resolves in the supine position
LP, if performed, should have an opening pressure <6 cm H2O

23
Q

Most effective therapy for low-pressure headache

A

epidural blood patch, typically performed by anesthesiologists

24
Q

Hypertensive headache

A

There is no compelling evidence linking mild to moderate hypertension with headache.

25
Pituitary tumor apoplexy requires immediate treatment with
corticosteroids and urgen neurosurgical consultation
26
Most common tumor of the third ventricle
**Third ventricle collloid cysts** - rare cause of acute neurologic deterioration and **sudden death** - usually congenital - hx of severe paroxysmal and episodic attacks of (typicall **frontal**) headache with N/V - the presumptive cause is the intermittent obstruction of CSF flow through the **foramina of Monro**
27
Acute angle-closure glaucoma diagnosis includes ocular pressure greater than
21 mm Hg although this is usually greater than 30 mm Hg
28
Remarks on preeclampsia
May present with headache after 20 weeks AOG up to 6 weeks postpartum Proteinuria is NOT required for diagnosis
29
Remarks on CVT
**Cerebral Venous Thrombosis** Mean age of 39 years More common in women May present with a "thunderclap" headache Diagnosed definitively with magnetic resonance venography LP can safely be performed in patients with CVT