[CLMD] Headache [Hon] Flashcards
What are the two general categories of headaches?
Primary headaches (benign HA disorders)
Secondary headaches (HA sign of organic disease)
What is important to aquire during a history of headaches?
Pain
- Intensity
- Location
- Duration
- Impact of exertion
*NOT JUST THE WORST HEADACHES, all of the headaches the patient gets
What is contained in a prodrome?
Before onset of HA
- Changes in energy levels
- Fatigue
- Muscle aches
-Aura
What are some unique associated symptoms with headaches?
N/V
Anorexia
Photophobia
Phonophobia
Dizziness
Ptosis/miosis
Watery eyes
What are common HA triggers?
Stress
Hormones
Diet
Enviornmental changes
Sensory stimuli
What are some of the worrisome signs associated with HA?
(pathoogical origin)
- “Worst HA”
- Onset of HA after age 50
- Atypical HA for patient
- HA with fever
-Abrupt onset
- Subacute HA with progressive worsening over time
- Drowsiness, confusion, memory impairment
- Weakness
- Abnormal neurological/medical exam
Define: Meningitis
Inflammation of the meninges surrounding brain and spinal cord, sometimes with associated encephalitis
What is the most common cause of bacterial meningitis in nearly all age groups?
Streptococcus pneumoniae
What is the most common cause of bacterial meningitis in the elderly?
Listeria monocytogenes
What is the most common cause of bacterial meningitis in teenagers and young adults?
Nisseria meningitidis
What is the most common cause of bacterial meningitis in unvaccinated children?
Hemophilus influenza
Symtpoms of meningitis?
Sudden high fever
Stiff neck
Severe HA
Confusion or difficulty concentrating
Seizures
Skin rash
How do you treat acute bacterial meningitis?
*TEST QUESTION*
IV steroids
- Dexomethasone
- Ceftriaxone
- Vancomycin
Define encephalitis
The presence of an inflammatory process of the brain in association with clinical evidence of neurological dysfunction
What are the common causes of infectious encephalitis in an adult?
VIRUSES
- HSV 1/2
- HIV
- West Nile
- Varicella zoster
- Treponema pallidum
What is the issue with the presentation of herpes simplex 1 encephalitis for diagnosis?
The clinical presentation is VERY SIMILAR to meningitis.
If you are unsure about the diagnosis, JUST ADD ACYCLOVIR (IV)
What type of encephalitis can mimic infectious encephalitis?
Autoimmune encephalitis
What are autoimmune encephalitis cases usually associated with?
SEIZURES
What is important in the treatment of patients with autoimmune encephalitis?
INITIATION OF TREATMENT
While you are awaiting test results, best to have the treatment already initiated
How do you treat autoimmune encephalitis?
High dose steroids
IVIg
Plasma exchange
Immunosuppresive agents
What are the two known etiologies of autoimmune encephalitis?
NMDA encephalitis
LGI1 encephalitis
NMDA Encephalitis
Gender?
Age?
Onset speed?
Gender = Women
Age = young/middle aged
Onset speed = rapid onset (less than 3 months)
What are the clinical symptoms of NMDA encephalitis?
Abnormal psychiatric behavior
Speech dysfunction
Seizures
Movement disorder
Decreased level of consciousness
Central hypoventilation
What are the abnormal lab results with NMDA encephalitis?
Abnormal EEG (extreme delta brush)
CSF (pleocytosis or oligoclonal bands)
What is a common association with NMDA encephalitis?
Teratoma
LGI1 Encephalitis
Gender?
Male
What is the hallmark seizure associated with LGI1 encephalitis?
Faciobrachial dystonic seizures
Describe what a faciobrachial dystonic seizure would look like
Brief seizures
Involve one side of the face, and the arm on the same side
Occurs frequently, hundreds of times per day
***DO NOT RESPOND TO ANTIEPILEPTIC DRUGS ALONG
What is the general rule for imaging with a HA?
“Worrisome history”?
One-time thorough neuroimaging study
Urgent imaging study and L.P, possibly arteriogram
Definition of:
Common migraine =
Classic migraine =
Common migraine = Migraine without aura
Classic migraine = Migraine with aura
Migraine info not included in fc
What is considered chronic migraine?
With HA 15 or more days per month, HA lasting 4 hours or longer
What is the most widely discussed theory for migraine cause?
Neurogenic inflammation
Typical location of tension type HA?
Bifrontal
Bioccipital
Neck
Shoulders
Band like
Cluster HA
Intensity?
Association?
Intensity = SEVERE, EXCRUCIATING
Association = Obstructive sleep apnea
Cluster HA
Location?
Unilateral/Bilateral?
Location = Orbitotemporal
Unilateral/Bilateral = ALWAYS UNILATERAL
What is an excellent treatment for migraines?
Triptans
What are the major contraindications to triptan use?
Cardiovascular disease
Raynauds
use with MAOIs or other 5HT1 agonists
What do you go to for chronic migraine treatment if all other pharmacologic treatments dont work?
BOTOX injections
What is trigeminal neuralgia?
Excruciating sharp, shooting, electrical quality pain
In the face
Treatment for trigeminal neuralgia?
Carbamazepine
Oxcarbazepine
What is SUNCT syndrome?
Shortlasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing
Paroxysmal hemicrania
Similar to?
Difference?
Responsive only to?
Similar to = cluster HA
Difference = shorter duration
Responsive only to= indomethacin
