Final Exam -- Headaches--Part III Flashcards
What is the cause of postherpetic neuralgia?
Herpes zoster virus
What are the risk factors for postherpetic neuralgia?
Older age, severity of initial rash and pain, and immunocompromised
The pain of postherpetic neuralgia is ___________ (unilateral/bilateral), sharp/stabbing, and affects which branch(es) of the trigeminal nerve?
Unilateral; V1*
What is the treatment for postherpetic neuralgia?
Amitriptyline or gabapentin. Capsaicin may help (decreases substance P)
Trigeminal autonomic cephalgias (TACs) are headache disorders with _____________ (unilateral/bilateral) trigeminal pain with _____________ (ipsilateral/contralateral) cranial autonomic features. Which headache disorders fit into this category?
Unilateral
Ipsilateral
Cluster headaches, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headaches with conjunctival injection and tearing (SUNCT)
Trigeminal autonomic cephalgias are thought to be due to abnormal hypothalamus and trigeminal activity.
Free card.
Cluster headaches feature excruciating unilateral orbital or temporal pain, accompanied by autonomic symptoms. Its overall prevalence is less than 1%. What percentage of patients experience autonomic symptoms? What sorts of autonomic symptoms are they?
97%*; parasympathetic symptoms such as lacrimation, injection, ptosis, miosis, etc.
True or false: patients with cluster headaches act restless and agitated.
True*
Cluster headache attacks typically occur 1-3 times daily. How quickly do they onset, and how long do they typically last?
Onset is rapid (5 minutes)*, and duration is between 15 minutes to 3 hours
Cluster headaches can occur like clockwork* and are common during ________ (sleep/waking).
Sleep*
What are some of the triggers for cluster headaches?
Alcohol, smoking, hypoxia
What are some of the acute treatment options for cluster headaches?
100% oxygen therapy, subcutaneous or nasal sumatriptan
What are some of the chronic treatment options for cluster headaches?
Verapamil or prednisolone with taper
Comparing cluster headaches and paroxysmal hemicranias, one of them can switch sides between attacks and the other always affects the same side. Which always affects the same side?
Paroxysmal hemicranias
Comparing cluster headaches and paroxysmal hemicranias, one of them can switch sides between attacks and the other always affects the same side. Which can switch sides?
Cluster headaches
Paroxysmal hemicranias last 2-30 minutes and typically occur 11-14 times/day. What feature is required to confirm diagnosis?
Resolution in 1-2 days with indomethacin* confirms diagnosis
Short-lasting unilateral neuralgiform headaches with conjunctival injection and tearing (SUNCT) last anywhere between 1 to 240 seconds. How often do they occur per day, on average?
60/day, though can be up to 200/day.
What is the most common autonomic finding of SUNCT?
Conjunctival injection and lacrimation.
What is the acute treatment for SUNCT?
IV lidocaine
What is the chronic treatment for SUNCT?
Lamotrigine, occipital nerve stimulation
Thunderclap headaches reach maximal intensity even faster than cluster headaches, in a few seconds to less than a minute. How long do thunderclap headaches last?
At least 5 minutes*, up to 10 days.
True or false: thunderclap headaches recur regularly and can be unilateral or bilateral.
False; they can indeed be unilateral or bilateral, but they do NOT recur regularly.
If a person has experienced a thunderclap headache, you must use CT* and lumbar puncture to rule out what possible underlying causes?
Subarachnoid hemorrhage or ruptured aneurysm.
What type of headache is commonly misdiagnosed as due to sinusitis?
Migraine
Are sinus headaches typically unilateral or bilateral?
Bilateral*
What is the most common cause of sinus headaches?
Viral infection
Sinus headaches are considered acute under _____ weeks, and chronic if more than _____ weeks.
Acute: less than 4 weeks; chronic: more than 12 weeks
What are the signs and symptoms of a sinus headache?
Nasal congestion* Purulent nasal discharge* Tooth pain Facial pain Pressure worse when bending over
What is the treatment for a viral sinus headache?
Observation, NSAIDs, saline irrigation, decongestants.
What is the treatment for a bacterial sinus headache?
Augmentin
Headache is the initial complaint in 20% of patients with what condition?
Brain tumor.
True or false: the pain of a brain tumor headache comes and goes, is deep and dull, and is worse in the evening.
False; the pain is constant* and is worse upon waking. (But yes, the pain is deep and dull.)
What are some of the symptoms in a patient with a brain tumor?
N&V, seizures, focal weakness, headache, changes in personality, visual changes.
What are the most common primary intracranial tumors?
Meningiomas, gliomas, pituitary adenomas
Where do the most common metastatic tumors arise from?
Lung cancer, breast cancer
What are the symptoms of a giant cell arteritis headache?
New headache, scalp tenderness, jaw claudication, sudden vision loss in one eye.
Testing for giant cell arteritis includes a temporal artery biopsy, ESR, and CRP levels. What ESR level may indicate GCA? How would you calculate ESR for a patient?
ESR over 50 mm/h may indicate GCA; for males, ESR = (age in years)/2; for females it’s (age in years+10)/2
Testing for giant cell arteritis includes a temporal artery biopsy, ESR, and CRP levels. What is a normal CRP level?
Less than 1 mg/dL (or less than 10 mg/L)
How would you treat giant cell arteritis?
IV methylprednisolone if vision loss is present, and oral prednisone, and low dose aspirin.
Which headaches discussed in class are more common in women?
Migraines* Trigeminal neuralgia* Paroxysmal hemicranias* Tension-type Basilar migraines Hemiplegic migraines Retinal migraines Sinus headaches GCA headache
Which headaches discussed in class are more common in men?
Cluster headaches*
SUNCT*
Which headaches discussed in class are typically in older patients (over age 50)?
Trigeminal neuralgia*
GCA headache (72)*
Postherpetic neuralgia ("older age")
Sinus headache is from 45-75
Which headaches discussed in class are typically in younger patients (under age 50)?
Migraines (30-39)* Basilar migraines (7-20) Hemiplegic migraines (12-17) Retinal migraines (under 40) Recurrent painful ophthalmoplegic neuropathy Cluster headaches (27-37) Paroxysmal hemicranias (34-41) SUNCT (48)
Sinus headache is from 45-75.
