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OPT 637 > Final Exam -- Headaches--Part III > Flashcards

Final Exam -- Headaches--Part III Flashcards

1
Q

What is the cause of postherpetic neuralgia?

A

Herpes zoster virus

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2
Q

What are the risk factors for postherpetic neuralgia?

A

Older age, severity of initial rash and pain, and immunocompromised

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3
Q

The pain of postherpetic neuralgia is ___________ (unilateral/bilateral), sharp/stabbing, and affects which branch(es) of the trigeminal nerve?

A

Unilateral; V1*

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4
Q

What is the treatment for postherpetic neuralgia?

A

Amitriptyline or gabapentin. Capsaicin may help (decreases substance P)

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5
Q

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?

A

Unilateral
Ipsilateral
Cluster headaches, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headaches with conjunctival injection and tearing (SUNCT)

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6
Q

Trigeminal autonomic cephalgias are thought to be due to abnormal hypothalamus and trigeminal activity.

A

Free card.

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7
Q

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?

A

97%*; parasympathetic symptoms such as lacrimation, injection, ptosis, miosis, etc.

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8
Q

True or false: patients with cluster headaches act restless and agitated.

A

True*

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9
Q

Cluster headache attacks typically occur 1-3 times daily. How quickly do they onset, and how long do they typically last?

A

Onset is rapid (5 minutes)*, and duration is between 15 minutes to 3 hours

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10
Q

Cluster headaches can occur like clockwork* and are common during ________ (sleep/waking).

A

Sleep*

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11
Q

What are some of the triggers for cluster headaches?

A

Alcohol, smoking, hypoxia

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12
Q

What are some of the acute treatment options for cluster headaches?

A

100% oxygen therapy, subcutaneous or nasal sumatriptan

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13
Q

What are some of the chronic treatment options for cluster headaches?

A

Verapamil or prednisolone with taper

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14
Q

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?

A

Paroxysmal hemicranias

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15
Q

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?

A

Cluster headaches

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16
Q

Paroxysmal hemicranias last 2-30 minutes and typically occur 11-14 times/day. What feature is required to confirm diagnosis?

A

Resolution in 1-2 days with indomethacin* confirms diagnosis

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17
Q

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?

A

60/day, though can be up to 200/day.

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18
Q

What is the most common autonomic finding of SUNCT?

A

Conjunctival injection and lacrimation.

19
Q

What is the acute treatment for SUNCT?

A

IV lidocaine

20
Q

What is the chronic treatment for SUNCT?

A

Lamotrigine, occipital nerve stimulation

21
Q

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?

A

At least 5 minutes*, up to 10 days.

22
Q

True or false: thunderclap headaches recur regularly and can be unilateral or bilateral.

A

False; they can indeed be unilateral or bilateral, but they do NOT recur regularly.

23
Q

If a person has experienced a thunderclap headache, you must use CT* and lumbar puncture to rule out what possible underlying causes?

A

Subarachnoid hemorrhage or ruptured aneurysm.

24
Q

What type of headache is commonly misdiagnosed as due to sinusitis?

A

Migraine

25
Q

Are sinus headaches typically unilateral or bilateral?

A

Bilateral*

26
Q

What is the most common cause of sinus headaches?

A

Viral infection

27
Q

Sinus headaches are considered acute under _____ weeks, and chronic if more than _____ weeks.

A

Acute: less than 4 weeks; chronic: more than 12 weeks

28
Q

What are the signs and symptoms of a sinus headache?

A 
Nasal congestion*
Purulent nasal discharge*
Tooth pain
Facial pain
Pressure worse when bending over
29
Q

What is the treatment for a viral sinus headache?

A

Observation, NSAIDs, saline irrigation, decongestants.

30
Q

What is the treatment for a bacterial sinus headache?

A

Augmentin

31
Q

Headache is the initial complaint in 20% of patients with what condition?

A

Brain tumor.

32
Q

True or false: the pain of a brain tumor headache comes and goes, is deep and dull, and is worse in the evening.

A

False; the pain is constant* and is worse upon waking. (But yes, the pain is deep and dull.)

33
Q

What are some of the symptoms in a patient with a brain tumor?

A

N&V, seizures, focal weakness, headache, changes in personality, visual changes.

34
Q

What are the most common primary intracranial tumors?

A

Meningiomas, gliomas, pituitary adenomas

35
Q

Where do the most common metastatic tumors arise from?

A

Lung cancer, breast cancer

36
Q

What are the symptoms of a giant cell arteritis headache?

A

New headache, scalp tenderness, jaw claudication, sudden vision loss in one eye.

37
Q

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?

A

ESR over 50 mm/h may indicate GCA; for males, ESR = (age in years)/2; for females it’s (age in years+10)/2

38
Q

Testing for giant cell arteritis includes a temporal artery biopsy, ESR, and CRP levels. What is a normal CRP level?

A

Less than 1 mg/dL (or less than 10 mg/L)

39
Q

How would you treat giant cell arteritis?

A

IV methylprednisolone if vision loss is present, and oral prednisone, and low dose aspirin.

40
Q

Which headaches discussed in class are more common in women?

A 
Migraines*
Trigeminal neuralgia*
Paroxysmal hemicranias*
Tension-type
Basilar migraines
Hemiplegic migraines
Retinal migraines
Sinus headaches
GCA headache
41
Q

Which headaches discussed in class are more common in men?

A

Cluster headaches*

SUNCT*

42
Q

Which headaches discussed in class are typically in older patients (over age 50)?

A 
Trigeminal neuralgia*
GCA headache (72)*
Postherpetic neuralgia ("older age")

Sinus headache is from 45-75

43
Q

Which headaches discussed in class are typically in younger patients (under age 50)?

A 
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.

OPT 637 (24 decks)

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