Final Exam -- Headaches--Part I Flashcards
Nearly 90% of headaches fall into one of these categories: migraine, tension-type, chronic daily, and cluster. Which of these types of the most commonly diagnosed?
Migraine
Nearly 90% of headaches fall into one of these categories: migraine, tension-type, chronic daily, and cluster. Which of these types of the most frequent?
Tension-type
Headache danger signs are symptoms which may indicate a serious underlying cause of the headache. These can be remembered by the acronym SNOOP. What does the S stand for?
Systemic symptoms–fever, weight loss, cancer, immunocompromised, pregnant
Headache danger signs are symptoms which may indicate a serious underlying cause of the headache. These can be remembered by the acronym SNOOP. What does the N stand for?
Neurologic symptoms–confusion, impaired consciousness, bilateral optic disc swelling, seizures
Headache danger signs are symptoms which may indicate a serious underlying cause of the headache. These can be remembered by the acronym SNOOP. What do the O’s stand for?
Onset is new (especially if over age 40*)
Other associated features–head trauma, drug use, pain worse with posture changes
Headache danger signs are symptoms which may indicate a serious underlying cause of the headache. These can be remembered by the acronym SNOOP. What does the P stand for?
Previous headache with history of progression–change in frequency, duration, intensity
Besides SNOOP, what are the two headache danger signs mentioned in class?
“First or worst” headache*
Headaches not reponding to treatment
If a patient has a danger sign for a headache, imaging should be done, and typically an MRI is preferred over a CT (though CT is preferred in emergencies). Lumbar puncture should be performed if you are suspicious for either of what two conditions?
Meningitis or subarachnoid hemorrhage
Migraine headaches affect activities of daily living, are ___________ (unilateral/bilateral) and typically occur how many times per month?
Unilateral, 1-4 times per month or less.
There were three types of migraine headaches discussed in class: without aura, with aura, and aura without headache (acephalgic). Which of these is the most common type?
Migraine without aura.
Comparing migraine with aura to migraine without aura, which requires at least five attacks for diagnosis?
Migraine without aura.
Comparing migraine with aura to migraine without aura, which requires at least two attacks for diagnosis?
Migraine with aura
The diagnostic criteria for a migraine without aura includes the headache lasting how long?
4 to 72 hours
The diagnostic criteria for a migraine without aura includes a headache with at least two of which four characteristics?
Unilateral location
Pulsating quality
Moderate or severe pain
Aggravation caused by routine physical activity (or headache causing avoidance or routine physical activity).
To be diagnosed as migraine with aura, the aura symptom(s) must be fully reversible. Two of what four characteristics must be present?
At least one aura symptoms spreading gradually over more than 5 minutes (and/or two or more symptoms occurring in succession)
Individual aura symptoms last 5 to 60 minutes
At least one aura symptom is unilateral
Aura accompanied by or followed within 60 minutes by a headache
The cortical spreading depression (CSD) theory of migraine pathophysiology states that aura are caused by a wave of excitation in parts of the brain. CSD is also said to activate the trigeminal system* and cause release of what neuropeptides?
Calcitonin gene-related peptide (CGRP)*
Substance P
Neurokinin A
The cortical spreading depression (CSD) theory of migraine pathophysiology states that aura are caused by a wave of excitation in parts of the brain. The permeability of the blood-brain-barrier is affected by what inflammatory markers?
COX-2, TNF-alpha, MMPs
True or false: the cortical spreading depression theory (CSD) states that nociceptor threshold is increased, and the magnitude of their response is increased as well.
False; the threshold is decreased (easier to feel pain), and the magnitude is increased
Migraines are associated with depletion of which endogenous substances? With excess of which substance?
Depletion of serotonin and estrogen; excess dopamine.
There are lots of possible triggers for migraines. Which three were bolded on the list in class?
Emotional stress, hormones in women, not eating/hunger.
A prodrome to a migraine occurs between 24-48 hours prior to the headache and involves what types of findings?
Depression, irritability, food cravings, neck stiffness, yawning, fatigue, difficulty concentrating, aversion to light, sounds, smells.
The most common type of aura is visual. It occurs over 5 minutes and may be a zig-zag pattern or a shimmering scintillating appearance. It may be a C-shaped and will leave a central scotoma
Free card.
True or false: the typical migraine headache lasts less than a day, is uilateral and involves a throbbing or pulsatile pain.
Mostly true–the duration can be anywhere from 4 hours to several days (so not necessarily “typically” less than a day)
____________________ is the perception of pain due to normally non-painful stimuli and can occur with a migraine.
Cutaneous allodynia
How would you treat a mild to moderate acute migraine?
NSAIDs or acetaminophen
How would you treat a moderate to severe acute migraine?
Triptans or a combination of triptans and NSAIDs
How would you treat an extremely severe acute migraine?
Subcutaneous sumatriptan, IV/IM antiemetic with diphenhydramine or dihydroergotamine, IV/IM ketorolac or dexamethasone
True or false: narcotics and opioids are good treatment options for acute migraines.
False; they are not recommended.
For acute therapy, treatment should start within how long of the onset of the migraine symptoms?
15 minutes
Over the counter acute therapy for migraines involves NSAIDs or acetaminophen, or Excedrin (combination of acetaminophen, caffeine, and aspirin). True or false: a large single dose is more effective than multiple smaller doses.
True.
Triptans are used to treat acute migraines and are agonists of __________.
Serotonin
True or false: when using triptans to treat an acute migraine, they should be taken early on, but not more than 3 times per week*
True.
Which triptan is available as a patch?
Sumatriptan*
Besides triptan treatment for acute migraines, you can use a triptan/NSAID combo, or dihydroergotamine.
Free card.
Which drug for migraines is preferred for anti-emesis?
Metoclopramide*
True or false: Prevention of migraines can be done with beta agonists.
False; it can be done with beta blockers.
Prevention of migraines can be done with antidepressants like _________ and __________.
Amitriptyline and venlafaxine
Prevention of migraines can be done with anticonvulsants like valproate (also used for ________ seizures), lamotrigine (also used for __________ seizures), and topiramate (which has what side effects?).
Valproate: general seizures
Lamotrigine: focal seizures
Topiramate: causes angle closure and myopic shift
Prevention of migraines can be done with a calcium channel blocker like _________ .
Verpamil
Avoiding triggers of migraines, getting regular sleep, regular meals, and regular exercise, and keeping a headache diary can all help with migraine management. What two other options were listed in lecture?
Acupuncture and transcutaneous electric nerve stimulation (TENS)
