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BMB Test 1 > B7.001 Big Case: Headache > Flashcards

B7.001 Big Case: Headache Flashcards

1
Q

3 components of neuro conditions

A

syndrome (symptoms and signs)
lesion (where in the nervous system?)
etiology

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2
Q

characteristics of migraine without aura

A 
attacks lasting 4-72 hours
2 of the 4:
1. unilateral
2. pulsating
3. moderate or severe
4. aggravation by or causing avoidance of routine physical activity
at least one of the following during the attack:
1. nausea / vomiting
2. photophobia and phonophobia
NO identifiable cause
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3
Q

what constitutes severe pain

A

have to stop activity as a result

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4
Q

4 common headache syndromes

A

migraine
chronic migraine
episodic tension-type
chronic tension type

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5
Q

difference between tension type and migraine headaches

A

severity

tension type mild/mod where a person may carry on activity

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6
Q

characteristics of migraine with aura

A

migraine headache features

preceded or accompanied by visual, sensory, or other focal neuro symptoms

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7
Q

2 most common neuro symptoms associated with migraine with aura

A

visual hallucinations of bright shimmering lights (fortification spectra)
tingling / numbness

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8
Q

status migrainosus

A

migraine lasting greater than 72 hours

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9
Q

what are episodic tension type headaches

A

recurrent headaches not fulfilling criteria for migraine

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10
Q

characteristics of episodic tension type headaches

A 
last from 30 min to 7 days
2 of the 4:
1. bilateral
2. pressing or tightening
3. mild to moderate
4. not aggravated by routine physical activity such as walking or climbing stairs
both of the following:
1. no nausea / vomiting
2. no more than one photophobia or phonophobia
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11
Q

most common headache type to present to physician

A

migraine

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12
Q

most common headache type overall

A

episodic tension type

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13
Q

what constitutes a chronic headache

A

daily or nearly daily

>15 days per month

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14
Q

transformed migraine

A

recurrent migraines become more frequent until they become a constant tension type headache with superimposed migraines
classified as chronic migraine due to history of migraine

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15
Q

reasons for chronic migraine

A 
spontaneous
medication overuse (rebound headache)
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16
Q

epidemiology of headaches

A

migraine prevalence 10%
tension : migraine = 5:1
women : men = 2: 1 for migraine with aura

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17
Q

what is the etiology of most headaches

A

cryptogenic / unknown

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18
Q

cranial pain sensitive structures

A 
skin
periosteum
orbits
paranasal sinuses
teeth
dural sinuses
blood vessels
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19
Q

common findings that usually DO NOT cause headaches

A 
DJD of the neck
sinus disease
refractive eye problems
TMJ
psych problems
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20
Q

does the brain itself feel pain?

A

no

21
Q

neurogenic migraine hypothesis

A

hypothesized when it was discovered that during migraine with aura, there was depressed cerebral activity during hallucinations
thought that part of the brain shuts down and then reactivation causes increased blood flow and headache

22
Q

vascular migraine hypothesis

A

blood vessel constriction > aura

blood vessel dilation > head pain

23
Q

trigeminal vascular migraine hypothesis

A

most current theory
synapse of neuron with blood vessel causes additional vasodilation and neurogenic inflammation
mediated by CGRP and serotonin which are now targets of drugs

24
Q

non specific headache abortive treatment

A 
don't target hypothesized migraine pathophysiology
analgesics : NSAIDs, opioids
caffeine (vasoconstrictor)
sedatives: butalbital
antiemetics
25
Q

specific headache abortive treatments

A

ergotamine (5HT1 receptor affinity) - not used much due to side effects

triptans: 5HT1 agonist
- most effective, based on trigeminal vascular theory

26
Q

medication overuse induced chronic headache

A

most common cause of chronic migraine is overuse of symptomatic migraine drugs and/or analgesics
diagnosis is important because patients rarely respond to preventative medications until withdrawn from the offending medication

27
Q

treatment for rebound headaches and transformed migraine

A

prophylactics

28
Q

types of headache prophylaxis

A 
antiepileptics
B-blockers
antidepressants: amitriptyline, venlafaxine (low doses)
NSAIDs
herbal therapies / vits / minerals
botulinum toxin injection
CGRP inhibitors: erenumab
29
Q

when are NSAIDs used in headache prophylaxis

A

usually only for menstruation related headaches because they are predictable
don’t want people on NSAIDs long term

30
Q

what is a cluster headache

A

less common primary headache syndrome

trigeminal autonomic cephalgia

31
Q

characteristics of cluster headache

A

severe, unilateral, peri-orbital, 15-180 minutes untreated
associated with 1 of the following on painful side:
conjunctival injection, lacrimation, rhinorrhea, miosis, ptosis, eyelid edema
frequency: qod to 8/day

32
Q

red flags in chronic headache

A

new onset > 35 yo
neuro findings including altered mental status
evidence of elevated intracranial pressure (optic nerve exam)
inflammation, fever, neck stiffness

33
Q

steps in localization of headache lesion

A
  1. determine subsystem involved
  2. determine likely localization based on pattern and nature of deficits
  3. confirm and refine localization with other subsystems
34
Q

components of CNS

A

cerebrum
brain stem
spinal cord

35
Q

components of PNS

A 
cranial nerves (from brain stem)
peripheral nerves (from spinal cord)
36
Q

upper motor neuron

A

motor neurons in the cerebrum that synapse in the brain stem / spinal cord with lower motor neurons to create an action in the face, arms, legs

37
Q

lower motor neurons

A

effector neurons that originate in the brain stem / spinal cord that act on the face, arms, legs

38
Q

what is the rule of thumb when looking at the position of UMN and LMN

A

UMN and LMN on contralateral sides of the brain/body

39
Q

what helps distinguish UMN from LMN lesions

A

reflexes
0-1 = low
2 = normal
3-4 = hyperreflexia

40
Q

what type of lesions presents with unilateral, asymmetric patterns of effects (hemiparesis)

A

focal

contralateral cerebral hemisphere to rostral brainstem

41
Q

focal lesions

A

pattern: unilateral, asymmetric
etiology: structural
pattern explained by: anatomy

42
Q

diffuse lesions

A

pattern: bilateral, symmetric
etiology: toxic or metabolic
pattern explained by: physiology

43
Q

modality to look at suspected focal lesion

A

MRI

44
Q

focal causes of acute headaches

A

vascular

trauma

45
Q

focal causes of chronic headaches

A

tumor

entrapment

46
Q

diffuse causes of acute headaches

A

toxins
drugs
electrolytes
organ failure

47
Q

diffuse causes of chronic headaches

A

nutritional
hereditary
degenerative

48
Q

diagnostics / treatment of focal lesions

A

imaging

surgical

49
Q

diagnostics / treatment of diffuse lesions

A

blood work

pharmacological

BMB Test 1 (29 decks)

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