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CDM II Fall Block > Eval of HA - Jaynstein > Flashcards

Eval of HA - Jaynstein Flashcards

1
Q

Whats the classic for SAH

A

Maximal intense

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2
Q

T/F Migraine will start off slow and increase

A

True

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3
Q

What is the 8th most common PCP complaint?

A

HA

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4
Q

Is there a strong genetic component with HA?

A

yes!

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5
Q

What is primary HA vs secondary HA?

A

Primary is from independently rather than from another medical issue

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6
Q

What are examples of primary HA?

A

Tension, migraine, cluster

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7
Q

What is secondary HA?

A

Ha from another issue

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8
Q

What is example of secondary HA?

A

Infection
Trauma
Stroke syndromes
REBOUND

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9
Q

What is approach to HA?

A
  • Good H&P
  • If secondary then you can do work up
  • If primary HA then deduce type of HA
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10
Q

What kind of infection cause HA?

A

sinusitis, meningitis, encephalitis

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11
Q

What kind of vascular cause HA?

A

CVA or TIA, SAH, dissections, temporal arteritis

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12
Q

What kind of CSF cause HA?

A

Spinal HA, pseudotumor cerebri

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13
Q

What are other causes of HA?

A

post-seizure, preeclampsia, intracranial mass

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14
Q

T/F You can’t dx the migraine until pt meets the criteria

A

True

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15
Q

T/F Patients who have headaches secondary to a serious underlying cause usually have distinct historical or exam findings

A

True

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16
Q

Whats age is a red flag in HA?

A

New HA in pt over 50 is bad until proven other wise

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17
Q

What are vascular sx that is red flag?

A

standing, lying down, valsalva, cough, or sexual activity

Can be due to elevated CSF, papilledema

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18
Q

If there is evidence of systemic/secondary HA they need what?

A

They need neuro imaging!

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19
Q

Is it common for kids to get random HA?

A

No its scary complaint

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20
Q

What sx is to the ER?

A
  • Worst HA of life (SAH, CNS infection)
  • Sudden onset reaching severe, maximal intensity within minutes - Thunderclap Headache – (ICH, meningitis)
  • Rapid onset with strenuousexercise (SAH, carotid artery dissection)
  • Neuro deficits, LOC, AMS
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21
Q

What kind of pt needs further workup?

A
  • Age < 5 or > 50 with no prior headache history (mass lesion)
  • Progressive in frequency or severity (medication misuse, subdural hematoma, mass lesion)
  • HA awakens pt from sleep
  • Change in HA pattern
  • Systemic symptoms – fever, neck stiffness
  • Temporal artery tenderness
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22
Q

what is systemic symptoms indicated for and can’t miss?

A

meningitis

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23
Q

what kind of PE should you do with HA?

A
  • Blood pressure
  • Fundoscopy
  • Auscultation for bruits
  • Temporal artery inspection and palpation
  • Meningismus
  • Neurologic exam: motor, sensory, coordination and gait
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24
Q

Should you get labs for primary HA?

A

Nope

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25
What kind of pt should get neuroimaging? CT w/o contrast is the 1st line
- Focal neurological signs - Onset of headache with exertion or sexual activity - Worst HA of life - CHI with LOC or on anticoagulants
26
T/F Research has shown that HA diaries/logs are more helpful for clinicians than labs or imaging in most cases
True
27
What are the characteristics of migraine
- HA lasting 4-72 hrs - Unilateral pain - Throbbing pain - HA worsens with exercise/activity - Moderate to severe pain - Associated N/V - Light and sound sensitivity
28
What is the most common HA?
Tension
29
Which HA causes the most disability?
Migraine
30
If they have auditory HA what should you do
get psych??
31
What is treatment of migraine?
32
T/F Earlier you tx migraine, the better it is?
True!!
33
Episodic HA can progress into what if we dont tx it?
Chronic HA syndrome
34
What should you do with migraine tx?
- To decrease the number of days pt has HA rather than set the expectation of no HA’s ever - Set limit to the number of HA related visits for pain control (2/month)
35
What is the tx of goal for migraine?
- Treat HAs promptly - Limit HAs to two hours or less - Optimize out pt treatment - Reduce healthcare costs – decrease ER visits - Minimize adverse SE of meds - Minimize use of narcotics
36
What are some preventative medications?
- Antidepressants - Anticonvulsants - Beta-blockers - CCB
37
Which is the best preventative for ppx migraine?
Bblocker
38
What are the 1st line abortive medications?
NSAIDs, APAP, ASA, Excedrin, Tordol Start 1st line
39
Whats best meds for otc?
Excedrin
40
Whats in excerdrin?
Caffeine, APAP and ASA
41
What is s/e for tordol been linked with?
Renal failure
42
What is the most effective DOSE for ibuprofen for pain relief? (not anti-inflammatory)
400mg, nothing bigger!
43
T/F all nsaids have therapeutic ceiling
True
44
What is black box of tordol?
?
45
Should you give them triptans right away?
Yes, if you think its migraine
46
Does triptans need dx for migraine?
No, does not need dx for us to prescribe
47
What are abortive medications?
NSAIDs, APAP, ASA, Excedrin, Tordol Triptans – Sumatriptan (Imitrex) Combinations – butalbital/APAP/caffeine (Fioricet) DHE Narcotics
48
Can you use narcotics for abortive?
you cant but plz don't
49
Whats the tx for mild-moderate migraine?
OTC analgesics, including nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, acetaminophen, and combinations containing caffeine
50
Caffeine containing meds at risk for what?
more effective but also have a higher risk of bringing on rebound headaches
51
What do aura put pts at most risk for?
Heart attack and occipital stroke
52
Why could aspirin be a good choice?
- Cardioprotective rather than increasing cardiovascular risks, as most NSAIDs do - Caution in patients whom you suspect SAH!
53
Who can benefit from migraine tx?
- more than one day HA per week - Miss work bc of HA - Associated complex symptoms
54
How long will migraine tx take to be effective?
8-12 weeks
55
What are good OTC tx to prevent migrain?
- Petadolex (adult and children) - Magnesium supplements - Coenzyme
56
Can you put aspirin for HA ppx?
NO!
57
Pt with migraine with aura, estrogen BC, what are they at risk for?
Stroke
58
What causes rebound HA?
recurring headache that is induced by repetitive and chronic use of acute medications.
59
T/F Acute med is ineffective in Rebound HA
True until medications have been withdrawn and washout or medication withdrawal occurs.
60
T/F Nearly all med used to treat HA can lead to rebound
True
61
What are common lifestyles triggers for HA?
- Emotional stress, depression, too little sleep, exercise or overactivity, skipping meals/fasting
62
What are common lifestyle food triggers for HA?
Chocolate, nuts,peanut butter, cheese, yogurt, sour cream, red wine, processed meat, MSG
63
What are common phsyical triggers for HA?
Menstrual cycle/hormonal changes
64
What are common environmental triggers for HA?
- Weather or seasonal changes - Travel through different time zone - Odors/pollution - Bright light
65
What are the pitfalls to HA?
- Misdiagnosing migraine - Over treating HA with medication linked to rebound HA - Under-treating migraine, limit of abortive treatment in lieu of analgesic - Blaming HA solely on stress
66
When to refer pt w/ chronic HA's?
Most pt w/ HA, chronic, can be managed in PC
67
When to refer pt w/ chronic HA's?
Consider obtaining a head CT (if not already done) and sending to neuro if: - <5 or >50 years old - Progressive headaches despite treatment - History of cancer - Uncertain dx
68
Whats the best drug in HA cocktail that Jaynstein?
Benadryl, compazine and tordol
69
Whats the most common s/e of zofran?
Prolonged QT

CDM II Fall Block (9 decks)

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