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Clin-Med B2 > 9: Headache > Flashcards

9: Headache Flashcards

0
Q

Status migrainosus

A

A debilitating migraine attack lasting for more than 72 hrs

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1
Q

Primary headache

A 
Migraine
Tension-type headache
Cluster headache
Paroxysmal hemicrania
Primary cough headache
Primary headache associated with sexual activity
Hemicrania continua
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2
Q

Chronic migraine

A

Migraine headache occurring on 15 or more days per month for more than 3 months

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3
Q

Persistent aura without infarction

A

aura sx persist for more than 1 week without radiographic evidence of infarction

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4
Q

Migraine triggered seizure

A

One type of epileptic attack occurs during or within 1hr after a migraine aura

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5
Q

Childhood periodic syndrome

A

1: cyclic vomiting
2: abdominal migraine
3: Benign paroxysmal vertigo of childhood

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6
Q

Abdominal migraine

A

an idiopathic recurrent disorder seen mainly in children and characterized by episodic midline abdominal pain manifesting in attacks lasting 1-72hrs with normally btw episodes. At least 5 attacks should have occurs

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7
Q

Cyclic vomiting

A

recurrent episodic attacks of vomiting and intense nausea lasting from 1hr to 5days. Attacks are associated with pallor and lethargy. There is complete resolution of sx btw attacks. At least 5 attacks

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8
Q

Migraine without aura- dx

A
  • at least 5 attacks
  • headache lasting 4-72hrs
  • at least 2 of following (characteristic of headache)
  • -unilateral location
  • -pulsating quality
  • -moderate or severe pain intensity
  • -aggravation by or causing avoidance of routine physical activity
  • during headache at least 1
  • -nausea and/or vomiting
  • -photophobia and phonophobia
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9
Q

Migraine with aura

A 
Aura- lasting 5-60mins
-fully reversible..
visual sx
sensory sx
dysphasic speech disturbance
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10
Q

Familial hemiplegic migraine (FMH)

A

presents with transient hemiplegia during aura

  • Ophthalmoplegia- double vision
  • Strabismus- paralysis of EOMs
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11
Q

Basilar migraine**

A

Visual field disturbances, cerebbellar signs (ataxia, dysarthria)
Cranial nerve involvement (vertigo)
Sensory and motor involvement

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12
Q

Bickerstaff’s migraine

A

basilar migraine in adolescent females
-Total blindness*, accompanied by admixture of vertigo, ataxia, dysarthria, tinnitus, perioral paresthesia, and occasional confusional state

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13
Q

Migraine -non-pharmacological tx

A 
identify and remove triggering factors
-alcohol
-food
-hunger
-irregular sleep patterns
-organic odors
-sustained exertion
-glare, flashing light
-acute stress
avoid environmental factors
-time zone shift, weather changes, pressure changes
Menstrual cycle
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14
Q

Migraine- pharm tx- acute

A

NSAIDS
Triptans* (DOC, selective 5HT1 agonist, contraindicated in pts with CVD*)
Ergotamine, dihydroergotamine (non selective 5HT1)
Metoclopromide, prochlorperazine (DA antagonists)
Narcotic analgesics

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15
Q

Migraine- prophylactic tx

A

Indication: 3 or more attacks a month

  • beta blocker: propranolol*
  • Ca channel blocker: Flunarizine*
  • 5HT agonist: methysergide, cyproheptadine
  • anticonvulsants: sodium valproate
16
Q

Tension type headache

A 
Headache- bilateral, tight, band like pain (not throbbing)
No nausea or vomiting
No prodrome
Not aggravated by physical activity
Frontal-occipital location
17
Q

Tension type headache- tx

A

Relaxation
NSAIDS
Prophylactic: TCA anti-depressants (Aitriptyline, Doxepin, Nortriptyline)

18
Q

Cluster headache-info

A 
Sudden periorbital or temporal pain
unilateral
Reaches crescendo within 5mins
Lasts 30mins-2hr
associated with
-homolateral lacrimation
-reddening of eye and nasal congestion
-ptosis
-nausea
Alcohol provokes (70%)
Nocturnal (50%; awakens pt within 2hrs of falling asleep)
Periodic (occur at the same hour everyday)
19
Q

Cluster headache- tx

A 
100% oxygen mask for 15min** (abortive)
Sumatriptan
Prednisone
Lithium
Ergotamine
20
Q

Chronic paroxysmal hemicrania

A

brief, severe unilateral orbital, supraorbital or temporal throbbing pain
Lasts 2-45mins*
At least 50 attacks a day
Pain with at least one of following
-1: conjunctival injection, 2: lacrimation, 3: nasal congestion, 4: rhinorrhea, 5: ptosis, 6: eyelid edema

21
Q

Chronic paroxysmal hemicrania- tx

A

Indomethacin (150mg daily or less): absolutely effective***

22
Q

Cough headache

A

headache on coughing, bending, sneezing, lifting
MRI is usually indicated to rule out structural anomalies/ brain tumor
-Chiari malformation

23
Q

sx associated with SERIOUS underlying cause of headache

A
  • worst headache ever
  • first severe headache
  • ‘Thunderclap’ headache
  • Subacute worsening over days or weeks
  • Abnormal neurological exam
  • Fever or unexplained systemic signs
  • Vomiting precedes headache
  • Induced by bending, lifting, coughing
  • Disturbs sleep or present immediately upon wakening
  • Known systemic illness
  • Onset age after 55yrs
24
Q

Headache- brain tumor/ space occupying lesion (SOL)

A

may worsen with exertion and change in position
pain appear with bending, lifting, coughing-> posterior fossa tumor
early morning headache that improves with day*
Unilateral papilledema

25
Q

Temporal arteritis

A

Headache- worse at night and on exposure to cold
Tenderness and redness over temporal arteries
Loss of vision or impaired vision
Polymyalgia rheumatica*
Jaw claudication* (pain with chewing)
Bx: dx
Tx: prednisone 4-6 weeks

26
Q

Acute glaucoma

A

IOP>21mmHg
Pathological cupping of optic disc
Loss of field of vision

27
Q

Acute glaucoma- tx

A
  • Block aqueous production: Timolol, Acetazolamide
  • Reduced vitreous volume: oral glycerol, mannitol
  • Facilitate aqueous outflow: pilocarpine*
  • surgical: Iridotomy
28
Q

Acute sinusitis

A

Pain or tenderness over sinuses
dx- CT shows mucosal thickening
tx- decongestants (Pseudoephedrine)

29
Q

Idiopathic intracranial hypertension (IIH)(Pseudotumor cerebri)

A

Increased ICP without any evidence of brain path
associated with VitaminA, Nalidixic acid, Danazol, Steroid withdrawal
Tx: Acetazolamide, Corticosteroids, Furosemide, CSF shunt (Ventriculoperitoneal shunt)

30
Q

Analgesic rebound headache- tx

A

Stop analgesics

Hydroxyzine*

31
Q

Trigeminal neuralgia- tx

A

Carbamazapine*
Radiofrequency ablation of a portion of the trigeminal ganglion
Anesthetic blocks

32
Q

Headache after Lumber Puncture

A

Increases on sitting and standing and decreases on reclining and on increasing abdominal pressure

33
Q

Headache after Lumbar Puncture- tx

A

if pain persists

  • Caffeine sodium benzoate**
  • Epidural blood patch (if CSB fails)

Clin-Med B2 (14 decks)

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