Clinical Perspectives of Headache Disorders Flashcards

1
Q

What is the difference between a primary and secondary headache?

A

A primary headache has no identifiable cause, whereas a secondary headache is due to some underlying cause (tumor, hemorrhage, meningitis, etc).

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2
Q

True/False. The dura surrounding the vascular sinuses and vessels is pain insensitive.

A

False. While dura over the skull is pain insensitive, dura around vascular structures is pain sensitive

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3
Q

What are the pain-insensitive brain structures?

A

Brain parenchyma, ependyma, choroid plexus, pia matter, arachnoid, dura over the skull

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4
Q

The falx cerebri is pain (sensitive/insensitive)

A

Pain-sensitive

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5
Q

True/False. Drainage of CSF in the supine position reduces headache.

A

True. Draining CSF in the erect position causes the brain to compress pain-sensitive structures

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6
Q

Lesions above the tentorium refer pain where?

A

Forehead and behind the eye

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7
Q

Pain in the ear and back of the head is often due to lesions where?

A

Posterior fossa

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8
Q

What red flags indicate a potentially dangerous headache?

A

Systemic or neurologic symptoms, sudden onset, older age, prior history, pattern change

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9
Q

A patient comes to the clinic feeling unwell, with minimal neck movement. You check Kernig’s sign. What indicates a positive test?

A

Severe pain in the lower back

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10
Q

A physician flexes the neck of a patient with meningitis. What would be the expected reaction?

A

Flexion of the lower extremities to reduce pain - this is called Brudzinski’s sign

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11
Q

What is one of the common causes of subarachnoid hemorrhage?

A

Ruptured intracranial aneurysm

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12
Q

What is sentinel hemorrhage?

A

Leakage from a vessel into the subarachnoid space before rupture of an aneurysm

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13
Q

What symptoms characterize a subarachnoid hemorrhage?

A

Sudden onset of a very severe headache

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14
Q

What are the most common sites of aneurysms?

A

PCA, ACA, middle cerebral bifurcation

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15
Q

What is the most common type of migraine?

A

Migraine without aura

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16
Q

What signs characterize a cluster headache?

A

Severe pain around the eye often accompanied by rhinorrhea and watery eyes, more common in men and smokers

17
Q

A basilar-type migraine includes headache with additional symptoms referred from the vertebrobasilar circulation. These symptoms include…?

A

Dysarthria, vertigo, tinnitus, deafness, diplopia, ataxia, decreased level of consciousness, bilateral sensory deficits

18
Q

This type of migraine includes weakness that may last longer than 60 minutes.

A

Hemiplegic migraine

19
Q

Cycling vomiting, abdominal pain, and benign paroxysmal vergito are associated with what unusual migraine disorder?

A

Childhood periodic syndromes

20
Q

Ophthalmoplegia migraines are a secondary headaches associated with what cause?

A

Cranial neuralgia - especially CN III

21
Q

A patient experiences approximately 3 days of headaches per month. Is preventative treatment recommended in this patient?

A

No - preventative treatment is recommended with 6 or more days of headaches per month

22
Q

What is the recommended first-line therapy for acute migraine treatment?

A

Triptans & NSAIDs

23
Q

A 36yo woman comes to the clinic with interest in beginning oral contraceptives. PMH is significant for 10-pack-year smoking history and migraines with aura. What is the recommended course of action?

A

The woman should NOT be prescribed oral contraceptives due to 9x higher risk of stroke. Other contraceptive methods should be considered

24
Q

True/False. Migraine without aura is associated with a twofold increase in the risk of stroke in women.

A

False. Migraine WITH aura is associated with increased stroke risk. This risk increases with use of oral contraceptives and smoking

25
Q

True/False. In women with increased risk of stroke and vascular conditions, non-estrogen-containing oral contraceptives should be used.

A

True. If women are also 35+ and have migraines with aura, no oral contraceptive should be used

26
Q

Pericranial tenderness characterizes this headache type?

A

Tension-type headache

27
Q

What symptoms generally accompany cluster headaches?

A

Unilateral orbital/temporal pain, rhinorrhea, lacrimation

28
Q

What population is at greatest risk for cluster headaches?

A

Men who are smokers

29
Q

What medication may be used to prevent cluster headaches?

A

Verapamil

30
Q

What medication may be used to treat active cluster headaches?

A

Prednisone, sumatriptan

31
Q

What are the two sites most likely for cervical artery dissection?

A

Internal carotid & vertebral arteries