Approach to HA Flashcards
Benign HA disorders
Migraine (Acute or Chronic) Tension Cluster Post-traumatic Drug rebound Trigeminal Autonomic Cephalgias (TACs)
Describe an aura
any sort of sensory disturbance that precedes a migraine.
Most commonly visual disturbance
Common associated symptoms of a HA
N/V
Anorexia
Photo/Phonophobia
Dizziness
Common Triggers of HA
Hormones Diet Stress Environment Sensory stimuli
Important things to assess in history for a HA complaint
Number Duration Pain quality Prodrome (aura) Meds LOC Seizure
PE for HA exam
Vitals Cardiac status Cervical OSE Optic exam CN exam
Patient reports “worst HA of their lives”. DDX?
Aneurysm/hemorrhage
Signs of secondary HA
“worst HA”
>50y
HA with fever
Abrupt
Common causes of bacterial Meningitis
S. Pneumo
H. Flu
Nisseria
Listeria
Common viral causes of meningitis
HSV
HIV
West Nile
Common fungal causes of meningitis
Crypto Neoformans
Toxoplasmosis (TORCH)
Granulomatous disease (Sarcoid)
Signs and symptoms of meningitis
Fever
Stiff neck
Seizure
NV with HA
Empiric treatment for suspected meningitis
IV Vanc + 3rd gen cephalosporin (ceftriaxone) + Steroid + Acyclovir (prophylactic for HSV)
Tests to perform for suspected meningitis
Blood cultures
Lumbar puncture
CSF findings in bacterial meningitis
Elevated opening pressure
Elevated WBC (PMN)
Elevated PRO
DECREASED GLU
CSF findings in viral meningitis
Normal Opening pressure
Lymphocytosis
Normal PRO
Normal Glucose
what would you call inflammatory process of the brain with neurologic dysfxn and is mainly causes by viruses?
Infectious Encephalitis
Common causes of infectious encephalitis
HSV 1 and 2
West Nile
Varicella Zoster
Syphilis
Infectious Encephalitis causes by HSV1 has a preference for what lobe of the brain and can develop what?
Temporal. Leads to fever, HA, ALOC, Seizures
Can lead to secondary autoimmune encephalitis
Autoimmune encephalitis
Anti-NMDA Ab or LGI1
rapidly progressive encephalopathy/psych disturbances with seizures.
Look for history of HSV-1 Encephalitis
NMDA encephalitis
Middle-aged Females Rapid onset <3m 4/6 of the following: Psych disturbane speech problem seizure Dyskinesia ANS dysfxn ALOC
What would be seen on EEG in a patient with NMDA encephalitis that is basically diagnostic?
Delta Brush
What neoplasia is associated with NMDA encephalitis?
Teratoma
A male patient begins to have dystonic seizures involving the face and arm that does not resolve with AED. What could be a possible diagnosis?
LGI1 Encephalitis
M>F
Sleep disturbances
Hippocampus mainly effected
Common Migraine characteristics
Moderate to Severe ADL's compromised 30-40y Females primarily 1-4/month Unilateral sharp pain NV Photo/Phonophobia
Chronic Migraine definition
> 15d/month
4h duration
3m
Hypothesized cause of a migraine
Neurogenic inflammation of the meninges caused CN V activation
Tension HA
Mild/Moderate Peak incidence 20-40y Waxing/Waning Band-Like distribution of dull aching squeezing pain Bilateral
Cluster HA
Severe/excrutiation pain usually orbitotemporal
ALWAYS unilateral
30m to 2h duration
Acute Treatment of Migraine
Analgesics
NSAIDs
DHE nasal spray
Triptans (5HT1 agonists)
Preventative treatment of Migraine
TCAs SSRIs SNRIs MAOIs B-Blockers CCB's AED's Literally every god damn drug class we're learning right now
Newest and promising treatment of Chronic Migraines
BOTOX injections every 3m
Acute treatment for cluster HA
O2 8L/min by mask
Triptans
Lidocaine
Trigeminal Neuralgia
aka “tic douloureux”
Excruciating CN V pain
Tx: Carbamazepine (Na channel blocker)
