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Foundations II (Cholley) > HA > Flashcards

HA Flashcards

1
Q

What is the 6th most disabling disorder in the world?

A

Migranes

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2
Q

How are HAs classified?

A
  • Primary (90%)
  • Secondary
  • Neuropathies & facial pains
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3
Q

What are primary HAs composed of?

A
  • Migraines
  • Tension HAs
  • Cluster HAs
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4
Q

What are red flags?

A
  • Abrupt onset of severe HA (“thunderclap”
  • Trauma associated HA w/ neurological deficit/ worsening sx
  • Focal neurological sx
  • Change in HA presentation
  • Systemic sx/illness
  • New onset in pt w/ CA or HIV
  • New onset after 50 yo
  • Wakes from sleep
  • Jaw claudication/temporal tenderness
  • Posture, exercise, valsalva provoked
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5
Q

What is the MC type of HA leading to pts seeking medical attention?

A

Migraines

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6
Q

Migraines are most common in what population?

A
  • White females
  • Low SES
  • Genetically predisposed (1st degree relatives)
  • Obese
  • Depression/anxiety
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7
Q

What triggers can cause a migraine?

A
  • Emotional stress
  • Hormones (women)
  • Not eating
  • Weather
  • Sleep disturbances
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8
Q

When do migraine prodrome sx typically appear?

A

24-48 hours prior to HA

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9
Q

What are prodrome sx of a migraine?

A
  • Yawning
  • Depression
  • Irritability
  • Cravings
  • Constipation
  • Neck stiffness
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10
Q

What are characteristics of a migraine aura?

A
  • Gradual, over 5 mins
  • Duration of 5-60 mins
  • Visual: shimmering or scintillating shapes/lines
  • Sensory: tingling on 1 side of face or limb
  • Language: dysphagia, difficulty w/ wording
  • Motor: weakness of face & limbs on 1 side
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11
Q

What are characteristics of migraine HA?

A
  • Duration 4-72 hrs
  • Unilateral
  • Throbbing, pulsating
  • Mod-severe pain
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12
Q

What sx are associated w/ a migraine HA?

A
  • N/V
  • Photophobia
  • Phonophobia
  • Osmophobia
  • Cutaneous allodynia
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13
Q

What is 1st line tx for migraine mild-mod attack?

A

NSAIDs (ibuprofen, naproxen, indomethacin, diclofenac, ketorolac)
- More effective if given early

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14
Q

What is 2nd line tx for migraine mild-mod attack?

A

Acetaminophen (Tylenol)

- Use if NSAID contraindication or previously unsuccessful

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15
Q

What is 3rd line tx for migraine mild-mod attack?

A

ASA/Acetaminophen/Caffeine (Excedrin)

  • For intermittent use
  • Common cause of med-overuse HA
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16
Q

What is 1st line tx for migraine SEVERE attack?

A

Serotonin agonists “Triptans”

  • Sumatriptan
  • Zolmitriptan
  • Eletriptan
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17
Q

What can happen if you use a “triptan” for > 2-3 times/wk?

A

Can lead to daily dull HA or migraine-like overuse HA

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18
Q

What is 2nd line tx for migraine SEVERE attack?

A

Ergotamines

  • Dihydroergotamine
  • Ergotamine/caffeine
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19
Q

What is alternative tx for migraine attack?

A

Opioids

  • Regular use can lead to tolerance, opioid-induced hyperalgesia, & med overuse HAs
  • Abuse & dependence
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20
Q

What is adjunct tx for migraine attacks?

A
  1. Antiemetic: For pts w/ N/V
    - Metoclopramide
    - Prochlorperazine
    - Promethazine
  2. Hydration
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21
Q

What type of pts should you administer migraine prophylaxis?

A
  • Pts w/ frequent (≥ 3 attacks/month), recurring & disabling sx
  • Migraines lasting over 48hrs
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22
Q

How do you prevent migraines?

A

Avoid triggers & modify behavior

  • Regular meals, exercise, sleep hygiene
  • Relaxation techniques, CBT
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23
Q

What was recently FDA approved for chronic migraine?

A

Botulinum toxin

- Inject into face, neck, head

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24
Q

How do you dx migraines?

A

Based upon subjective & objective findings

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25
Q

What is the MC primary HA disorder? What population is mostly affected?

A
  • Tension HA

- Mid teens to < 50, Men

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26
Q

What are the RFs for tension HAs?

A
  • stress/anxiety
  • depression
  • too little or too much sleep
  • OSA
  • muscular tension
  • cervical spondylosis
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27
Q

What are the clinical findings of tension HAs?

A
  • daily or episodic HAs lasting from 30mins to 7 days
  • Bilateral
  • Pressing/tightening
  • Mild-mod intensity
  • Increased tenderness of pericranial tissue
28
Q

What is the 1st line tx for acute tension HA attack?

A
  • NSAIDs (ibuprofen = drug of choice, naproxen)
  • Acetaminophen
  • ASA
29
Q

When are tension HAs considered “chronic”?

A

If > 7-9 HAs per month

30
Q

How do you tx chronic tension HAs?

A

Amitriptyline

  • Reduces frequency & intensity
  • Start w/ low dose
31
Q

What is non-pharmacological therapy for tension HAs?

A
  • CBT, relaxation, EMG

- PT, acupuncture, spinal manipulation

32
Q

What is the least common primary HA d/o? What population is most affected?

A
  • Cluster HA

- > 30 yrs (peak in 40s), men

33
Q

What are RFs for cluster HAs?

A
  • 1st degree relative
  • prior head injury
  • ciggs
  • high alcohol
  • male
  • type A personality
34
Q

What are triggers of cluster HAs?

A
  • d/o of circadian rhythm
  • sleep
  • volatile smells
  • smoking
  • sildenafil
35
Q

How do cluster HAs present?

A
  • 15 to 180 mins, up to 8 times/day

- Piercing, exploding, penetrating

36
Q

What are the 2 forms of cluster HAs? Describe them.

A
  1. Episodic (80-90%): lasts 2-16 wks followed by free period of 6 mos to yrs
  2. Chronic: no sustained free episodes for > 1 month
37
Q

What are sx of a cluster HA?

A

On the affected side:

  • injection, lacrimation
  • eyelid edema
  • Miosis, ptosis
  • nasal congestion, rhinorrhea
  • forehead & facial sweating
  • Fullness in ear
38
Q

How do you tx acute cluster HAs?

A
  • 1st line = O2 & sumatriptan/ zolmitriptan
  • Prednisone taper
  • Intranasal lidocaine
39
Q

What can be used for prophylaxis of cluster HAs?

A

CCB verapamil

40
Q

Secondary HAs can be attributed to…

A
  • head/neck trauma
  • vascular d/o
  • non-vascular intracranial d/o
  • substance or its withdrawal
  • Infection
  • d/o of homeostasis
  • psychiatric d/o
41
Q

What type of HAs are considered secondary?

A
  • Post-concussion
  • Analgesic rebound
  • Pseudotumor cerebri
  • Temporal arteritis
  • Trigeminal neuralgia
  • Subarachnoid hemorrhage
42
Q

What are features of a concussion? What is it caused by? What does it result in?

A

Mild TBI

  • Caused by direct blow
  • Results in rapid onset of neurological impairment that resolves spontaneously
43
Q

What type of imaging is used to r/o intracranial hemorrhage?

A

CT & MRI

44
Q

How are concussions managed?

A

Rest (physical & cognitive)

45
Q

What are drug rebound HAs (AKA - overuse HAs) related to?

A

Acute symptomatic meds:

  • opioids
  • butalbital/analgesic
  • ASA/acetaminophen/caffeine
46
Q

What is the most significant factor in the development of rebound HAs?

A

Lack of awareness by health providers & pts

47
Q

What are sx of rebound HA?

A
  • nausea
  • asthenia
  • difficulty concentrating
  • memory problems
  • irritability
48
Q

When do rebound HAs resolve?

A

2 months after discontinuation of analgesia

49
Q

What is pseudotumor cerebri? What population is most affected?

A

AKA - idiopathic intracranial HTN

- Women of childbearing age

50
Q

What are the MC presenting sx of pseudotumor cerebri?

A
  • variable, non-specific
  • pain of unusual severity
  • intermittent or persistent
  • +/- exacerbation w/ changes in posture
  • +/- relief w/ NSAIDs or rest
51
Q

What are PE findings of pseudotumor cerebri?

A
  • Papilledema *
  • Visual field loss
  • Abducens palsy
52
Q

How do you tx pseudotumor cerebri?

A
  • wt loss
  • decrease Na
  • carbonic anhydrase inhibitors
  • loop diuretics
  • serial LPs
  • optic nerve fenestration
  • CSF shunting
53
Q

Describe: temporal arteritis. What population is most affected?

A

AKA - Giant cell arteritis

  • MC systemic vasculitis
  • Peak = 70-79 yo
54
Q

What is the clinical presentation of temporal arteritis?

A
  • Abrupt or insidious
  • HA
  • Neck, torso, shoulder, pelvic pain
  • jaw claudication
  • fever
  • constitutional s/s (malaise, wt loss, night sweats)
55
Q

What are PE findings of temporal arteritis?

A
  • 50% have tenderness over SF temporal artery
  • nodularity/thickening over SF temporal artery
  • scalp pain
  • 10% develop central retinal artery occlusion
56
Q

What is the hallmark of GCA?

A

Elevated ESR & CRP

57
Q

What is the standard diagnostic procedure for temporal arteritis?

A

Temporal artery biopsy

58
Q

How do you tx temporal arteritis?

A

High dose corticosteroids due to danger of blindness

- Sx improve in 72hrs

59
Q

Describe trigeminal neuralgia. What population is most affected?

A

“Tic Douloureux”

  • compression of trigeminal root
  • Peak = 60-70 yo
  • MS pts, females
60
Q

What are clinical features of trigeminal neuralgia?

A
  • sharp electric shock, lasting few secs to several mins

- may be triggered by simple actions

61
Q

What are dx studies for trigeminal neuralgia?

A
  • Based on H & P

- MRA w/ gadolinium

62
Q

What are red flags of TN?

A
  • trigeminal sensory loss
  • bilateral
  • < 40 yrs of age
63
Q

How do you tx TN?

A
  • Antidepressant & anti-seizure (carbamazepine effective)
  • Narcotics rarely effective
  • Surgical decompression
64
Q

What are RFs for subarachnoid hemorrhages?

A
  • HTN
  • Smoking, alcohol
  • sympathoimetic drugs
  • polycystic kidney disease
  • coarctation of aorta
  • marfans
65
Q

What are sx complaints of SAHs?

A
  • sudden onset worst HA of life
  • worse on exertion
  • N/V
  • meningism
  • neck stiffness
66
Q

SAH emergency workup should include…

A

Noncontrast CT

- If negative, get LP

67
Q

How do you tx SAH?

A

Emergent surgery

- Surgical clip

Foundations II (Cholley) (25 decks)

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