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Neurology > HA 2 > Flashcards

HA 2 Flashcards

1
Q

What is needed to diagnose a sinus HA?

A

Acute sinusitis:

  • Purulent nasal d/c
  • Pathological sinus findings on imaging
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2
Q

True or false: chronic sinusitis is a cause of sinus HA

A

False–does not count for diagnosis unless progresses into an acute episode

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3
Q

Activation of the TNC results in what?

A

Activation of cranial PNS nerves extending into the sinus cavities and tear ducts

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4
Q

True or false: sinus pressure and symptoms are not usually associated with migraines

A

False

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5
Q

What is the most common HA that is seen by the neurologist?

A

Migraines

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6
Q

What is the acute treatment for migraines?

A
  • NSAIDs
  • Triptans
  • Dihydroergotamine (DHE)
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7
Q

What is the rescue therapy for migraines HAs?

A

Steroids PO

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8
Q

What is the MOA of triptans?

A

5HT agonists to selectively constrict the meningeal arteries by blocking the release of vasoactive peptides

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9
Q

What are the FDA approved drugs for migraine prevention? (3)

A
  • Topiramate
  • Timolol
  • Propranolol
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10
Q

What is the use of botulinum toxin in treating migraines?

A

Prophylactically for chronic migraine suffers

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11
Q

What is the “indication” for butterbur? Side effects?

A
  • Migraines

- Liver toxicity

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12
Q

What are the supplements for migraine prophylaxis?

A
  • Mg supplementation

- High dose B2

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13
Q

True or false: gabapentin is only used for acute attacks of migraines

A

False–prophylactically

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14
Q

What is the diuretic that may help with migraine prophylaxis?

A

Candesartan

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15
Q

What type of antidepressants are used for migraines?

A

TCAs

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16
Q

What are the three major TCAs?

A
  • Amitriptyline
  • Nortriptyline
  • Imipramine
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17
Q

The use of abortive treatments for migraines should be limited to how many times per week? Why?

A

2

Avoid the development of rebound HAs

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18
Q

What may happen with numerous, untreated migraines?

A

Increase in frequency, duration, and severity d/t changes in pain generators

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19
Q

How long does it take for migraine prophylaxis to be effective?

A

8-12 weeks

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20
Q

What is the pathophysiology of Trigeminal Autonomic Cephalgias (TACs)?

A

Activation of the trigeminal autonomic reflex that causes “allergy” symptoms on the side of the reflex

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21
Q

What are the characteristics of cluster HAs?

A

Piercing, unilateral stabbing pain, accompanied by ipsilateral lacrimation and nasal congestion

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22
Q

Which gender is usually affected with cluster HAs?

A

Males

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23
Q

How often do cluster HAs recur? When in the day do they usually occur?

A

1-10 attacks per day, usually at night

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24
Q

How long do episodes of cluster HAs happen?

A

30-120 minutes

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25
Q

What is the seasonal pattern of cluster HAs?

A

usually in the fall and spring

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26
Q

What is the prophylactic treatment for cluster HAs?

A
  • Verapamil
  • Topiramate
  • Li
27
Q

What is the bridge therapy for cluster HAs for the prophylactic meds to kick in?

A

Starting dose of oral steroids

28
Q

What is paroxysmal hemicrania?

A

Cluster HAs that usually occur a ton per day–up to 40 times/day

29
Q

What is the diagnostic criteria for paroxysmal hemicrania?

A

HA has to abort with indomethacin use

30
Q

What is SUNCT?

A

Short-lasting unilateral neuralgiform HA with conjunctival injection and tearing

31
Q

What are the s/sx of SUNCT?

A

Similar to trigeminal neuralgia, but with ipsilateral ANS s/sx

32
Q

What is hemicrania continua? Treatment?

A
  • HA that is constant 100% of the time, with associated ipsilateral ANS s/sx
  • Indomethacin
33
Q

What is a chiari malformation?

A

Posterior fossa contents that slip through the foramen magnum–congenital malformation

34
Q

What percent of HA in HA clinics are d/t medication overuse?

A

80%

35
Q

What is the most important risk factor for chronic daily HA?

A

Medication overuse

36
Q

What are the characteristics of analgesic overuse HAs? (Bilateral or unilateral? Character? Intensity?)

A
  • bilateral
  • Pressing/tightening
  • Mild-moderate intensity
37
Q

What is combination medication overuse HA?

A

-Same as analgesic overuse HA except intake of combination meds for more than 10 day/month for 3+ months

38
Q

What is the diagnostic criteria for Combination MOH?

A

Same as MOH HAs, but:

-Intake of combination medication on more than 10 days/month for 3 months

39
Q

What is the pathophysiology of MOH HAs?

A

Continued use of analgesics upregulates 5HT receptors, leading to a lower threshold for HA development

40
Q

What is the frequency of MOHs?

A

Daily or nearly daily

41
Q

What are the accompanying s/sx of MOH HAs?

A
  • GI disturbances

- Anxiety/irritability

42
Q

What type of HA usually causes med overuse?

A

Migraines

43
Q

Why is it necessary to choose the most efficacious med for HAs?

A

Use of suboptimal medications leads to increased usage

44
Q

What were the results of the head-HUNT study, in terms of the increased risk for migraines and non-migraines with medication overuse?

A

Overuse causes:

  • Relative risk of chronic migraine elevated by 13.3 times
  • risk of chronic non-migraine HA elevated 6.2 times
45
Q

True or false: when migraines patients with a non-headache medical condition take analgesics daily for that condition, they can develop MOH

A

True

46
Q

What is the role of barbiturates in HA?

A

No studies that prove or refute the efficacy for butalbital-containing agents in the treatment of acute migraines HAs

47
Q

What is the role of opioids in the treatment of HAs?

A

Better reserved for use when other meds cannot be used or when sedation effects are not a concern

48
Q

What is the role of the trigeminal nucleus caudalis?

A

Pain input nucleus in the trigeminal pathway

49
Q

What is the role of the mesencephalic nucleus of the trigeminal nerve?

A

Proprioception of the face

50
Q

What is the trigeminal autonomic reflex?

A

Since the Trigeminal nucleus caudalis lies adjacent to the superior salivatory nucleus, there is cross communication, leading to HAs

51
Q

What are the contraindications for triptans?

A

Smokers
MI
Strokes

Anything where you want to avoid constriction of arteries

52
Q

What is the definition of migraines? Treatment?

A

15 or more migraines / month for more than 3 months

Quarterly botox injections

53
Q

What is the most common manifestation of TACs?

A

Cluster HAs

54
Q

What is the acute therapy for cluster HAs? (3)

A
  • Oxygen
  • DHE
  • Triptans
55
Q

What is the primary prophylactic therapy for cluster HAs? What should always be checked, prior to administering this?

A

Verapamil

EKG should be obtained

56
Q

What is the diagnostic criteria for hemicrania continua?

A

Must resolve with indomethacin administration

57
Q

For the diagnostic criteria of AOH, a HA has to be present for how many days /month?

A

15 days

58
Q

For the diagnostic criteria of AOH, the intake of analgesics has to be equal to or greater than what amount? For how long?

A

More than 15 days/month for 3 months

59
Q

For the diagnostic criteria of AOH, what has to happen to the severity of the HA with analgesic use?

A

Increased intensity

60
Q

For the diagnostic criteria of AOH, the HA has to resolve within what timeframe after analgesic discontinuation?

A

2 months

61
Q

True or false: MOH HAs are, by definition, never relieved by the usual amount of medications?

A

False–can provide short term relief.

62
Q

What is the upper limit of using medications (days/month) in order to avoid MOH?

A

10 days / month

63
Q

What is the treatment for MOHs?

A

Detox

64
Q

Inability to look up = ?

A

Midbrain issue

Neurology (23 decks)

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