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D&T2 Exam 2 > Common Headache Disorders - Ferguson > Flashcards

Common Headache Disorders - Ferguson Flashcards

1
Q 
scalp 
sinuses
meninges 
pial arteries
arteries and major veins
midbrain 
are these sensitive to pain
A

yes

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2
Q 
ventricles
choroid
brain parenchyma (except midbrain)
small parenchymal and dural veins
sensitive to pain
A

no

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3
Q

What specific area of the brainstem is known to cause headaches

A
  • midbrain
  • dorsal raphe nucleus
  • high concentration of serotonin
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4
Q

What causes migranes

A
  • brainstem: abnormal instability or activation of certain cells which spread peripherally and stimulate the
  • trigeminal nerve
  • chemoreceptors
  • autonomic nervous system
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5
Q 
what type of headache am i?
unilateral headache  
deep ache or throbbing sensation 
phonophobia, photophobia, and/or nausea vomiting 
worsen with exertion 
relieved by rest
A

migraine without aura

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6
Q

what is aura

A 
perceptual distrubace experienced prior to headache onset with can manifest as
visual disturbance
sensory disturbance
motor disturbance
auditory disturbance
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7
Q

what is complicated migraine

A

same as migraine with aura but aura is quite dramatic and can last longer

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8
Q

complicated migraines can mimic what

A

stroke

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9
Q

basilar migraine is associated with what part of the brain

A

brainstem

posterior cerebral circulation

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10
Q

what are common symptoms of basilar migraine

A

vertigo
dysathra
ataxia
diplopia

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11
Q

what is the most severe form of basilar migraine

A

Bickerstaff’s migraine

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12
Q

what are clinical symptoms of Bickerstaff’s migraine

A

total blindness followed by vertigo, ataxia, dysarthria and/or tinnitus

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13
Q

For Basilar migraine, compare the onset of headache and neurological symptoms onset

A

headache onset follows 20-30 min following neurologic symptom onset

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14
Q

describe the pain and location for basilar migraine

A

occipital throbbing pain

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15
Q

what are types of drugs used for abortive or rescue therapy for migraines

A

NSAIDS
5HT1
dopamine antagonists
combinations

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16
Q

what 5HT1 agonists are available orally

A

Triptans

Ergots

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17
Q

what 5HT1 agonists are inhaled or comes in a subcutaneous form

A

Sumatriptan
Zolmitriptan
Frovatriptan

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18
Q

When should prophylactic therapies be used for migraines

A

severe enough to cause functional impairment

OCCRUS 3 TIMES PER MONTH

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19
Q

What type of drug is used for prophylactic use of migraines ? Specific categories?

A

Beta- adrenergic blockers

  • calcium channel blockers
  • Tricyclic antidepressants
  • anticonvulsants
  • serotonergic durgs
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20
Q

Propranolol

Atenolol

A

Beta adrenergic blockers

21
Q

Verapamil

A

Calcium channel blockers

22
Q

Amitriptyline

Nortriptyline

A

Tricyclic antidepressants

23
Q

Gabapentin
Valproic acid
Topiramate
Levetiracetam

A

Anticonvulsants

24
Q

Cyproheptadine

A

Serotonergic drugs

25
Q

define cluster headache

A

episodic headache: 1-3 short duration (15-30 min in length)

  • severe unilateral stabbing periorbital or temporal pain
  • 3-6 weeks
26
Q

what are some associated symptoms for cluster headache

A 
conjunctival injection/lacrimation
miosis
ptosis
eyelid edema
rhinorrhea/nasal congestion 
perspiration 
remarkable circadian rhythm
27
Q

Where in the brain do cluster headaches derive from

A

hypothalamus: prominent autonomic symptoms

secondary activation of trigeminal-autonomic reflex via trigeminal-hypothalamic pathway

28
Q

what are 2 acute treatment options for cluster headaches? which one is more effective

A

oxygen: high concentration for 15 minutes, MOST EFFECTIVE ABORTIVE AGENT, if pain is still present prescribe–>
Triptans

29
Q

when should prophylactics be used for cluster headaches

A

should only be started at onset of cluster

30
Q

What are two prophylactic options for cluster headaches

A

high dose steroids

calcium channel blockers

31
Q

what is the most prevalent headache syndrome

A

tension headache

32
Q

what do tension headaches feel like

A

squeezing or pressure around the head

33
Q

What are symptoms that are never associated with tension headaches

A

NAUSEA OR VOMITING

34
Q

what are non-pharmacologic treatment options for tension headaches

A

stress reduction
biofeedback
cognitive behavioral therapy
improved sleep hygiene

35
Q

what are abortive treatment options for tension headaches

A

acetaminophen

NSAIDS

36
Q

what are two prophylaxis treatment options for tension headaches

A

tricyclic antidepressants

antiepileptic: Gabapentin

37
Q

Idiopathic intracranial hypertension IIH is a disturbance that causes what

A

increased intracranial pressure without evidence of an intracranial mass, hydrocephalus or dural venous stenosis

38
Q

Idiopathic intracranial hypertension is usually seen in what patients? what can create this problem

A

young obese females

and if they take tetracylcines, oral contraceptive pills, hypervitaminosis A

39
Q

describe the symptoms of idiopathic intracranial hypertension

A

new onset continuous daily headache that worsens with cough, sneezing, and moving into the supine position

40
Q

what is the initial work up of idiopathic intracranial hypertension

A

MRI, find nothing then
LP: done in lateral decubitus position in order to obtain accurate opening pressure
ophthalmologic exam

41
Q

what is the non-pharmacologic treatment for idiopathic intracranial hypertension

A

weight loss

42
Q

what are medical treatment options for diopathic intracranial hypertension

A

removal of offending drugs

use drugs that decrease CSF production

43
Q

name 2 drugs that decrease CSF production

A

Acetazolamide

Topiramate

44
Q

what are the 2 secondary headache disorders

A

idiopathic intracranial hypertension

Giant cell arteritis

45
Q

symptoms of Giant cell Arteritis

A
  • unilateral throbbing headache in temporal scalp
  • complain of concomitant jaw claudication, diffuse joint pains, visual disturbances, and transient monocular vision loss
  • seen in 50 yrs or greater
46
Q

what is the gold standard for making the diagnosis for giant cell arteritis

A

temporal artery biopsy

47
Q

treatment for Giant cell arteritis

A

Steroids

48
Q

what is the diagnostic criteria for common migraine

A

at least 5 attacks fulfilling the following:

  • lasts 4-72 hours
  • unilateral, pulsating, debilating
  • nausea or photophobia
49
Q

what makes classic migraine different from common migraine

A

presence of an aura

D&T2 Exam 2 (14 decks)

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