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Medicine II > HA > Flashcards

HA Flashcards

1
Q

primary causes of migraine

A

i. HA & associated features are the disorder
ii. Tension 69%
iii. Migraine 16%
iv. Cluster 0.1%

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2
Q

secondary causes of migraine in order

A

i. HA caused by other disorder
ii. Infection 63%
iii. Trauma 4%
iv. Vascular Disorder 1%
v. SAH <1%
vi. Tumor 0.1%

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3
Q

what types of infections cause headaches

A

sinus infection- pressure on sinuses, tops of the teeth

meningitis- nuchal rigidity, fever, rash, body aches

dental abscess

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4
Q

headaches in the population M:F

A

b. 5:9 M:F

cluster more common in males
migraines more common in females

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5
Q

TTH presentation

time
and location

A

pain is constant an daily an worse late in the day

bilateral
vise-like band

vi. Emanates from neck and shoulders

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6
Q

“Featureless” HA

A

TTH

NO associated sx like n/v

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7
Q

ix. S.C.A.L.P (PE)

A
  1. skin
  2. Connective Tissue
  3. Aponeurosis í connected to the skin
  4. Loose connective tissue
  5. Pericranium íoutside of the bony cranium
  6. Occipital nerves are superficial and attached to the capitis muscles
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8
Q

triggers for TTH

A
  1. Stress
  2. Depression/Anxiety
  3. Posture
  4. Jaw clenching when sleeping
  5. Female - get more tension HA’s than males do
  6. Middle age
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9
Q

how to differentiate TTH in a person with anxiety or depression

A

pts with mental health issues wake up with HA and they get worse throughout the day

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10
Q

chronic TTH

A 
at least 10 episodes month
at least 30 minutes
location bilateral pressing or tigehtning 
no n/v
no photophobia
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11
Q

best way to treat a HA

A

at the onset
on’t treat your HA like an earthquake
OTC analgesic snd drink a ton of water

less likely to progress and reoccur
caffeine can be helpful

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12
Q

caffeine helps HA becasue

A

is a vasoconstrictor

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13
Q

what to avoid with TTH

A

Opiates

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14
Q

amitriptyline (TCA)

A

works really good as a low dose for TTH

usually want to take it at night because it can cause drowsiness

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15
Q

EMG

A

biofeedback therapy that can be used to treat TTH

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16
Q

ALT to medication for TTH

A

acupuncture

maybe massage

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17
Q

TENS tx

A

Transcutaneous Electrical Nerve Stimulation

causes nerve stimulation of mm and can reset nerves and help mm to stay more relaxed in
TTH of in pts with chronic back pain

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18
Q

onset of migraines

A

6-8 in boys

after menses in women

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19
Q

Fhx in what % of pts with migraines

A

70%

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20
Q

Pathophysiology of migraines

A

vasonstriction followed by vasodilation theory kind of debunked

looks like more of a nuero vascular issue with spreading that leads to trigeminal vascular system triggering and cortical spreading depression that depolarizes the cortex –> leads to blood vessel dilation

triggers inflammatory mediators to be released

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21
Q

triggers for migraine

A
  1. FH - predisposing factor 70%
  2. Stress 80%
  3. Lack/excess of sleep>50%
  4. Missed meals 57%
  5. Foods (chocolate, EtOH) 27-38%
  6. Hydration status definitely a trigger for migraine HA
  7. Light 38%
  8. Noise, glare
  9. Menstruation (catamennial migraines) 65%
    a. Raises a whole new tx option for hormones
    b. Progesterone - related to HA
    i. Estrogen was added to the progesterone only BC b/c HA was a huge SE
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22
Q

Unilateral
Throbbing
Episodic with early onset

A

migraine

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23
Q

red flag for migraine onset

A

almost always start in childhood or teen years but always by the 20s

24
Q

four stages of a migraine

A

prodrome
aura
migraine
postdrome

25
Q

migraine presentation

A
  1. Unilateral
  2. Throbbing
  3. Episodic with early onset - teens & young adults
  4. Anorexia
  5. N/V
  6. Photophobia/phonophobia/osmophobia
    a. Osmophobia - sensitivity to smells
  7. Cognitive impairment
    a. Word finding
    b. Executive fxn can become a problem
  8. Blurred vision
  9. Migraine HA build gradually, last hours to days
  10. Focal neurological deficits, or sensations may preceed onset
26
Q

what % of pts have aura with migraine

A

25%

27
Q

mc presentation of MS

A

optic neuritis in 40 year old woman

if you have a new onset migraine you really need to think about this

28
Q

how to determine if a migraine is chronic and need prophylaxis

A

insurance is ver stingy with migraine medications like triptans

need to revaluate if they are using them a lot

missing school or work

decrease risk of neurological damage
menstral migraine

29
Q

mngmt of acute migraine

A

NSAID
triptan
sumatriptain+naproxen
antiemetic

30
Q

triptan injection SE

A

feel like shit for 20 minutes and then you’re better
triptan injections hurt
they cause muscle spasm

31
Q

preventative management for migraines

A

lifestyle mods

BB/Anti htn meds (meto, timo, propra)

TCA antidepressants
:amitriptyline in small doses at bedtime

anticonvulsants topiramte, valproate

CCB

32
Q

why would you want to avoid a BB for prophylactic mngmt

A

not in marathon runners (HR already low)
make you tired so be careful
heart blocks, really anything where the hr is too low

33
Q

suppresses appetite can treat migraines

A

anticonvulsants

topiramate (topamax) and valproate

34
Q

cluster ha pathophys

A

trigemino vascualr stimulation like migraine but in a different part of the brain (hypothalamus?)

35
Q

typical trigger with cluster

A

alcohol
stress
glare
specific foods

36
Q

CM of cluster HA

A 
deep 
unilateral
peri-orbital 
trigeminal area
agitation
37
Q

timing/duration of cluster HA

A
  1. Pain is “explosive” in nature

4. Episodic, episodes last weeks

38
Q

associated features of cluster HA

A

(ipsilateral parasympathetic activation):

a. Nasal congestion, rhinorrhea
b. Lacrimation and redness of eye
c. Horner syndrome (sympathetic deficit associated with parasympathetic activation with injury to ascending fibers surrounding dilated carotid artery)

39
Q

tx for cluster ha

A

oxygen tx –> shuts down inflammatory process

triptans

40
Q

preventative mgmt

A

<2 mo
prednisone high dose

> 2mo verpamil

41
Q

less common causes of HA

A 
analgesia rebound
substance use or withdrawl'
trauma
mass
GCT arteritis 
subarachnoid hemorrhage 
sunken brain
42
Q

what is sunken brain

A

post lumbar puncture

43
Q

WORST HA OF MY LIFEEE

A

subarachnoid hemorrhage

44
Q

e. Abnormal neurological examination with HA

A

is reason for worry
red flag
TIA or stroke

45
Q

Systemic signs

A

rash
fever

these should make you think of infx

46
Q

vomiting proceeding the HA

A

worried about ICH

or intracranial pressure increase

47
Q

pain with pressure change

A

worried about ICH

or intracranial pressure increase

48
Q

if a HA wakes you from sleep

A

and it’s not cluster think intra cranial pathology

49
Q

Onset >55

A

j. Onset >55 - late onset is a bad sign

intra cranial thing

50
Q

classic migraine does or does not have an aura?

A

has an aura

51
Q

timing needed to dx cluster

A

5 episodes from 1 every other day to 8 days without other causes

52
Q

imitrex

A

vasodilator used for migraine accompanied with SE like N/v

53
Q

1st line for migraine

A

tylenol

54
Q

d. Subacute worsening over days suggests what origin of a HA

A

bleeding

55
Q

g. Vomiting preceding HA

A

ICP

Medicine II (21 decks)

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