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INTERNAL MEDICINE > CHAPTER 1 3 HEADACHE > Flashcards

CHAPTER 1 3 HEADACHE Flashcards

1
Q

what are the two types of headache?

A

primary and secondary headache

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2
Q

causes of primary headache

A 
tension-type
migraine
idiopathic stabbing
exertional
cluster
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3
Q

causes of secondary headache

A 
systemic infection
head injury
vascular disorder
subarachnoid hemorrhage
brain tumor
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4
Q

it is a type of headache in which the headache and its associated symptoms is the disorder itself

A

primary headache

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5
Q

type of headache where it is caused by exogenous disorder

A

secondary headache

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6
Q

pain occurs when?

A

peripheral nociceptors are stimulated in response to tissue injury, visceral distension or other factors

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7
Q

what are the cranial structures that are pain producing

A 
scalp
meningeal arteries
dural sinuses
falx cerebri
proximal segments of the large pial arteries
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8
Q

what are the cranial structures that are not pain producing?

A

ventricular ependyma
choroid plexus
pial viens
brain parenchyma

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9
Q

key structures that involved in primary headache

A

large intracranial vessels
dura mater
peripheral terminals of trigeminal nerve
caudal portion of the trigeminal nerve
rostral pain processing regions such as the ventroposteromedial thalamus and cortex
pain modulatory systems such as hypothalamus and brainstem structures

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10
Q

what do you call the innervation of large intracranial vessels and the dura mater by the trigeminal nerve

A

trigeminovascular system

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11
Q

examples of cranial symptoms that may suggest trigeminal autonomic cephalagias

A 
lacrimation
conjunctival injection
nasal congestion
rhinorrhea
periorbital swelling
aural fullness
ptosis
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12
Q

What are the symptoms of the headache that suggest that a serious underlying disorder

A 
sudden onset headache
first severe headache
worst headache ever
vomiting that precedes the headache
subacute worsening over days or weeks
pain induced by bending, lifting, cough
pain that disturbs sleep or presents immediately  upon awakening
known systemic illnesses
onset after age 55
fever or unexplained systemic signs
abnormal neurologic symptoms
pain associated with local tenderness
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13
Q

what is the essential first step in the evaluation

A

careful neurologic examination

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14
Q

history of recent-onset headache should be evaluated by?

A

computed tomography

magnetic resonance imaging

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15
Q

general evaluation of acute headache includes the?

A

cranial arteries by palpation
cervical spine by the effect of passive movement of the head and by imaging the investigation of cardiovascular
renal status by blood pressure monitoring and urine examination
eyes by funduscopy
intraocular pressure measurement and refraction

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16
Q

what other aspect should be included in the physical examination?

A

psychological assessment because there is relationship between pain with anxiety and depression

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17
Q

what is quiescent migraine syndrome?

A

when recurrent headache is activated by pain that follows otologic or endodontic surgical procedures

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18
Q

brain tumor is a rare cause of headache

A

True

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19
Q

treatment of secondary headache focuses on?

A

treatment of underlying condition

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20
Q

what do acute severe headache with stiff neck and fever suggest?

A

meninigitis

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21
Q

how do you diagnose meningitis?

A

lumbar puncture

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22
Q

in meningitis is there is striking accentuation of pain with eye movement?

A

yes

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23
Q

meningitis is easily mistaken for migraine when there is associated symptoms such as?

A

pounding headache
photophobia
nausea
vomitting

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24
Q

what do acute, maximal in <5 mins, severe headache lasting >5 min with stiff neck without fever suggets?

A

intracranial hemorrhage

25
Q

if the intracranial hemorrhage is small what would be the result of CT scan and how to confirm it?

A

CT scan may be normal and LP is used to confirm

26
Q

head pain in tumor is characterized as?

A

intermittent deep, dull aching of moderate intensity, which may be worsen during exertion and associated with nausea and vomitting

27
Q

vomitting that precedes the appearance of headaches by weeks is characteristic of?

A

posterior fossa brain tumors

28
Q

history of amenorrhea or galactorrhea with head pain is suggestive of?

A

prolactin-secreting pituitary adenoma

29
Q

headache in patient with known malignancy is suggestive of

A

cerebral metastasis

carcinomatous meningitis

30
Q

headache appearing abruptly after bending, lifting, or coughing can be suggestive of

A

posterior fossa mass
chiara malformation
low cerebrospinal fluid volume

31
Q

what do you call the inflammatory disorder of arteries that frequently involves the extracranial carotid circulation

A

temporal (giant cell) arteritis

32
Q

incidence of temporal (giant cell) arteritis

A

a common disease in elderly
>50
woman> men

33
Q

untreated temporal arteritis can lead to?

A

blindless

34
Q

pathophysiology of blindness in untreated temporal arteritis

A

involvement of ophthalmic artery and its branches

35
Q

treatment for temporal arteritis

A

glucocorticoids

36
Q

what are the typical symptoms of temporal arteritis

A 
headache
polymyalgia
rheumatica
jaw claudication
fever
weight loss
37
Q

dominant symptom?

A

headache associated with malaise and muscle aches

38
Q

what is the quality of pain in px with temporal arteritis?

A

throbbing
dull and boring
superimposed episodic stabbing pains similar to sharp pains that appear in migraine

39
Q

pertinent finding in physical examination in px with temporal arteritis

A

scalp tenderness

brushing of hair or resting the head on a pillow is not possible

40
Q

what could worsen the headache and aggravate?

A

nightime and exposure to cold

41
Q

additional findings in pe in px with temporal artheritis

A

reddened, tender nodules

red streaking of the skin

42
Q

diagnosis of temporal arteritis

A

erythrocyte sedimentation rate and temporal biopsy

43
Q

treatment for temporal arteritis

A

prednisione 80 mg daily for the first 4 to 6 weeks

44
Q

characteristic of headache in glaucoma px

A

prostrating headache associated with severe eye pain

45
Q

physical examination findings in px with glaucoma

A

eyes is red with fixed moderately dilated pupil

46
Q

when can we say that it is chronic headache?

A

15 days or more per month

47
Q

treatment for chronic headache

A

treat the underlying illness
give tricylics such as amitriptyline or nortiptyline (1kg) and given 12 hr before the expected time of awakening to prevent excess morning sleepiness

48
Q

what is medication over-use headache

A

overuse of analgesic medication for headache can aggravate headache

49
Q

how to manage a medication overuse in outpatient?

A

reduce the medication and practice medication diary

50
Q

how to manage overuse of medication in inpatient?

A

acute medications are withdrawn and the px must be hydrated well

51
Q

what is the clinical manifestation of new daily persistent headache?

A

the px can recall the moment of onset

52
Q

what is the most common cause of new daily persistent headache

A

subarachnoid hemorrhage

52
Q

what is the most common cause of new daily persistent headache

A

subarachnoid hemorrhage

53
Q

what is the characteristic of low CSF volume headache?

A

head pain is positional

begins when the px is sitting upright and resolves upon reclining

54
Q

what is the gold standard diagnosis for low CSF headache

A

MRI with gadolinium

55
Q

initial treatmet for CFS volume

A

bed rest

with persistent pain, you can give IV caffeine

56
Q

characteristic of head pain in raised CSF pressure headache

A

chronic migraine

history of generalized of headache that is present in walking and improves as the day goes on

57
Q

how can you diagnose a raised intracranial pressure?

A

visual obscurations

58
Q

treatment for raised intracranial pressure

A

acetazolamide (250-500 mg bid)

INTERNAL MEDICINE (12 decks)

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