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Med Path Fall 2020 > HA > Flashcards

HA Flashcards

1
Q

Most common neurological disordrer

A

HA
50% + americans report at least 1 HA per year.
1/3 people have severe headaches.

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2
Q

__% of HA are high risk

A

1%

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3
Q

Most headaches are caused by ____ or ____ problems

A

Muscle contraction or blood flow

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4
Q

How many different types of HA

A

over 100

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5
Q

3 types of primary HA

A

Tension-Type Headache (TTH): 78%
Migraine: 13-18%
Cluster: 0.4%

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6
Q

Common location of:
TTH
Migraine
Cluster

A

TTH: Pain like a band squeezing the head. Across forehead.

Migraine: Unilateral. Visual changes are typical of classic form.

Cluster: Pain is in and around 1 eye. (but does not originate in eyes)

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7
Q

Are primary or secondary more commonly associated with severe findings?

A

Secondary. HA caused due to systemic problem.

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8
Q

Secondary headaches may be due to

A 
Fasting
Sinusitis
Infections- meningitis, dental abscess. 
Stroke
Trauma 
Tumor 
Refractive/ocular disease. Less urgent. 
Medication over use
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9
Q

HA red flags

A
  • New HA type in pt over 50
  • HA increasing in frequency or severity
  • HA wakes pt from sleep
  • HA + systemic finding such as fever or coughing/straining
  • HA + neurological symptoms. Numb, tingling, slurred speech
  • HA + papilledema
  • HA with altered mental status. Confusion, memory probs
  • HA with nausea or vomiting if NEW.
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10
Q

majority of all HA

A

TTH

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11
Q

TTH two types

A

Acute/episodic or chronic (15+ days per month)

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12
Q

TTH more common in women or men

A

Women

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13
Q

Why are TTH due to a dysfunction of pain perception

A

Persistent myofascical input (constant contracting muscle somewhere) causing pain and sterile inflammation (No infection)

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14
Q

Signs and symptoms of TTH

A 
Bilateral, dull, band like tightness 
4-6 hours 
No photophobia or phonophobia (hearing sensitivity)
Doesn't worsen with physical activity 
Responds to OTC meds
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15
Q

TTH causes

A

Emotional/physical stress
depression and anxiety
Working in awkward positions- Tech neck.

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16
Q

TTH Tx

A

OTC NSAIDS
Caffeine
Exercise
Stress reduction therapy

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17
Q

How much of the population is affected by migraines

A

13%

Female> Male

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18
Q

Migraineurs

  • Most prevalent in ages:
  • __% have immediate family Hx
  • History of
  • Strong correlation with
A

25-55 years old (may be associated with arteriolosclerosis)
70% with FHx
History with car sickness and vertigo as child
Strong correlation with depression/anxiety due to neurological differences in serotonin/dopamine.

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19
Q

4 stages of a migraine

A
  1. Prodrome
  2. Aura
  3. Attack/HA
  4. Postdrome
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20
Q

Migraine stage 1: Prodrome

A 
1-2 days prior to attack 
These could be signs of a migraine coming: 
Constipation
Depression
Diarrhea
Drowsiness 
Irritability
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21
Q

Migraine stage 2: Aura

A

occurs right before attack (20-30 mins)

Usually visual

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22
Q

Migraine stage 3: Attack

A

Moderate to severe pain

lasts several hours- 3 days

23
Q

Migraine stage 4: Postdrome

A

Migraine hangover.
Malaise
Fatigue

24
Q

What is happening in the brain that causes a migraine?: Neurovascular theory

A

Neurobiology + Vascular function in the brain

Pt’s who get migraines have lowered threshold to stimuli, which leads to cortical hyper-excitability followed by cortical spreading depression (CSD). Excessive firing of neurons that activates trigeminal nerves and causes pain in dural blood vessels.

Hyper-excitability starts in occipital lobe and spreads to central sulcus.

25
Q

Cortical spreading depression (CSD)

A

Excessive firing of neurons that activates trigeminal nerves and causes pain in dural blood vessels.

26
Q

How to diagnose migraine using 54321

A

5 or more attacks

4 hours- 3 days in duration

2 or more of the following:
Unilateral, throbbing, moderate/severe pain, causes avoidance of routine physical activity

1 or more of the following:
Nausea, vomiting, photophobia, phonophobia

27
Q

Two main Migraine types

A
  1. Migraine without aura (80%) Common migraine
  2. Migraine with aura (20%) Classic migraine
Others:
Retinal (not a true migraine) 
Childhood periodic syndromes 
Complication 
Probable migraine- hasn't met all 54321 criteria 
Chronic migraine
28
Q

Common migraine (without aura) has a 25% increased risk of ___ and ___

A

Stroke and MI

29
Q

What types of HAs improve with sleep

A

Migraines

30
Q

Signs/symptoms of common migraines without aura

A

Progressively worsen, unilateral, throbbing
Nausea, vomiting
photo and phono phobia
Anorexia
Improves with sleep
Conj injection and tearing due to neuromuscular prob

31
Q

In what type of migraine might you see conjunctival injection and tearing

A

Common and classic

32
Q

How does 54321 change with classic migraine (with aura)

A

24321

Only have to have 2 attacks, not 5

33
Q

Migraine with aura (classic migraine) has 2x risk of ___ in women and ____

A

MI in women

Ischemic stroke in male/females

34
Q

Fancy name for migraine with aura

A

scintillating scotoma

35
Q

How does a scintillating scotoma (aura) progress?

A

may last 20-60 mins.

  1. Initial paracentral scotoma
  2. Enlarging scotoma 7 mins alter
  3. Scotoma obscuring much of central vision 15 mins later
  4. Break up of scotoma at 20 mins
36
Q

Pts may have aura without headaches. More common in

A

Men over 40

37
Q

Retinal migraine is due to

A

Vascular spasm causing an interruption in ciliary or retinal circulation. Visual disturbances are result of retinal ischemia.

Amaurosis fugax- may be due to stroke. Sudden loss of vision in 1 eye.

38
Q

Signs/symptoms of retinal migraines

A

Transient, monocular visual disturbance
Usually brief
HA before or after the visual episode
Usually under age of 40

39
Q

Most common cause of transient vision loss under age 45

A

Aura

40
Q

Ocular manifestations of migraines

A

Aura
Hemianopsia: Persistant VF defect up to weeks after attack.
Horners syndrome- rare
Normal tension glaucoma- associated

41
Q

Normal tension glaucoma is associated with

A

Ocular manifestations of migraines

42
Q

Are OTC meds effective for migraines?

A

Usually no

43
Q

How to tx migraines

A

Prophylactically
Abortive tx- take in the moment to decrease severity or duration
Avoid triggers- food, alcohol, stress, lights, smells

44
Q

Cluster headaches

A

Severe, unilateral pain usually involving the eye.
Attacks occur in clusters- last for weeks to months. Headaches last 15-180 mins. May occur once every other day or up to 8x per day.

45
Q

How common are cluster headaches, in which genders and what are risk factors?

A

Men 0.4%, women, 0.08%

80% are heavy smokers and 50% are alcoholic users

46
Q

What makes cluster headaches so painful?

A

Involves changes to the trigeminal pain processing.

47
Q

Autonomic features of cluster HA

A

Nasal congestion, facial sweating, lacrimation, conj redness, mitosis, and ptosis. Usually unilateral.

48
Q

TMJ syndrome

A

Pain in trigeminal and facial nerve areas
Originates in the jaw and worsens with chewing
Differentiating sign: Jaw clicking or locking.
5% of population, ages 15-40. F>M

49
Q

Ocular causes of HA

A 
Angle cosure
Uveitis 
Scleritis
Optic neuritis 
Refractive disorders and muscle imbalance 
Metastatic orbital tumors 
Severe dry eyes
50
Q

Ophthalmodynia periodica-

A

Shooting eye pain that diminishes quickly in one eye.

Prob occurs along CN V ophthalmic branch.
Often hx of migraines 
Benign 
Cause unknown
Tx art tears
51
Q

Benign Episodic pupillary mydriasis

A

Acute, unilateral mydriasis. Blown pupil. Always co-manage with neuro.

Women> men
Hx of migraines

associations: Blur, light sensitivity, HA. Similar to dilated symptoms.

52
Q

Headache work up

A 
History 
Cranial nerve eval 
Sinus eval 
Blood pressure
refraction
Binocular/accom testing 
Complete ocular health assessment 
Visual field testing 
Refer to neuro
53
Q

Consider brain scan if you suspect

A 
Tumor 
hx of seizures 
Recent head trauma 
Signifcant changes to HA 
Abnormal neuro signs

Med Path Fall 2020 (20 decks)

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