HA, Cohen Flashcards

1
Q

Primary HA

A

no obvious pathologic cause

migraine, cluster, tension type

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2
Q

secondary HA

A

pathological cause: tumor hemorrhage infection

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3
Q

warning signs and Sx of secondary HA

A
single HA
sudden onset
onset HA after age 50
recent onset HA <6 mo
systemic disease
change in HA pattern
neuro Sx or abnormal neuro exam
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4
Q

PE for HA

A

general appearance
fever or abnormal vital signs, supple neck
mental status, speech, LOC
vision and retinal discs, pupils, EOMI, papilledema
asymmetry of strengths or reflexes
babinski

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5
Q

imaging for recurrent migraines

A

no CT or MRI unless recent change in HA pattern, focal neurologic signs or Sx

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6
Q

imaging for nonmigraine HA

A

CT MRI role unclear

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7
Q

imaging more likely to show cause for HA

A

MRI

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8
Q

imaging for HA in pregnancy

A

MRI w/o contrast

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9
Q

LP necessary for

A

Dx meningitis or encephalitis or possible carcinomatous meningitis
confirm subarachnoid hemorrhage but no blood on CT or MRI

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10
Q

increased opening pressure in LP

A

it can help Dx pseudotumor cerebri or idiopathic intracranial HTN

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11
Q

Dx primary headache syndrome

A

clinical features

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12
Q

characteristics of migraine features

A
sick HA with light and sound sensitivity
worse with activity
build up intensity
 4-72 hours
aura or sensory or motor deficits before pain
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13
Q

migrain criteria

A
>5 attacks
>2 of following:
-unilateral
-pulsating
-mod- severe intensity
-aggravation routine physical activity
>1 of following:
-nausea and/or vomiting
-photophobia, phonophobia
No evidence of Hx or exam of disease that might cause HA
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14
Q

most common HA type that patients seek medical care

A

migraine

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15
Q

migraine demographics

A

W>africans>asians

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16
Q

genetics in migraines

A

possible 80% close family members with migraines too

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17
Q

transmission of migraine genetics

A

mother to daughter

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18
Q

mutations for familial hemiplegic migraine

A

Na and Ca Channels in neurons

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19
Q

causes of migraines

A

environmental factors “triggers”
psychiatric disorders
hormones: migraines can end with menopause

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20
Q

triggers for migraines

A

fasting, medication, circadian rhythms, environment, hormones, stress/overexertion

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21
Q

visual auras before migraines

A

blurred vision or blind spots
seeing flashing lights
seeing jagged lines
difficulty in focusing

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22
Q

sensory or motor changes before migraines

A

numbness or tingling of lips, face of hands on one side body

weakness in arms or legs, usually one side body

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23
Q

speech or language changes before migraines

A

inability to understand words

loss of speech or inability to speak normally

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24
Q

wolff concluded migraine pain from

A

reduction blood flow to occipital Cx in visual aura and the frontal or parietal cortices with other auras
actual pain from increase blood to brain

25
cortical spreading depression
sudden brief depolarization of cortical neurons, followed by reduction in neuronal depolarization and synaptic transmission
26
pain for migraine on PET
region of pons active up to 30 minutes before there is an increase in blood flow to brain
27
increased activity to CN V leads to what
secondary vasodilation and inflammation of dura mater | "trigeminovascular activation"
28
what NT are released from pons in migraine
serotonin CGRP substance P NO
29
what is increased in urine from migraine attack
increased 5-hydroxyindoleacetic acid in urine from increased release serotonin 5-hydroxytyptamine
30
migraine ends with what
when neurons stop releasing more serotonin
31
sumatriptan
serotonin 1b 1d agonist | effective in stopping migraine attack by binding these inhibitory serotonin autoR
32
what is in migraine center
dorsal raphe nucleus | locus coeruleus
33
antagonists to what molecule help stop migraine
CGRP | help show not purely vascular process because CGRP has no role in vasoconstriction
34
most common type HA
tension type
35
clinical features tension type HA
dull, b/l, squeezing, tight non pulsating routine physical acitivty does not aggravate pain no vomiting and more than one of : nausea, photophobia, phonophobia MSK component, cervicogenic medication seldom necessary
36
average length chronic tension type HA
>15/mo | avg duration >4 hr/day if untreated and history >6 mo
37
chronic tension type HA should not take what
more than one analgesic a week
38
common findings with tension type HA
``` HTN depression anxiety insomnia DM/hypoglycemia ```
39
pain pills in people with frequent HA
cause increase frequency
40
cluster HA characteristics
brief 15 minutes-2 hours one sided around eye often 1 hr after falling asleep occur daily or multiple times a day for weeks or mo at a time "season"
41
intense unilateral HA causing patient to bang head on wall
cluster HA
42
autonomic features of cluster HA
``` conjunctival injection lacrimation congestion rhinorrhea swelling miosis ptosis eyelid edema ```
43
weight gain abnormal vision and HA
secondary HA
44
pseudotumor cerebri
idiopathic intracranial HTN
45
signs pseudotumor cerebri
-progressive diffuse HA with intermittent loss of vision in 1+ eyes especially with eye movements - obese young women!! E and P maybe or acutane - increased intracranial P, from overproduction CSF opening P >25 papilledema
46
what can occur in idiopathic intracranial HTN if not Dx early
irreversible loss of visual acuity often extraocular palsy CN VI III IV
47
Dx idiopathic intracranial HTN
spinal tap P and imaging
48
Tx idiopathic intracranial HTN
weight loss, corticosteroids, carbonic anhydrase inhibitors, topiramate
49
Trigeminal neuralgia | tic douloureux
brief shooting pain lasting only a sec triggered by facial contact one branch CN V
50
triggers for trigeminal neuralgia
touching face eating shaving applying lipstick or makeup
51
causes trigeminal neuralgia
idiopathic
52
age of trigeminal neuralgia
uncommon under 50 y.o | unlesss brainstem lesion, MS tumors
53
Giant Cell Arteritis
temporal example of vasculitis non-infectious inflammation of aa leading to gradual occlusion involves superficial temporal a (off external carotid a)
54
temporal arteritis can spread how leading to what complication
to adjacent internal carotid a | reaching ophthalmic a and cause complete visual loss via ischemia
55
other Sx temporal arteritis
fatigue difficulty chewing pain in neck and shoulders
56
giant cell arteritis component of
polymyalgia rheumatica
57
Dx temporal arteritis
ESR and CRP | confirmed by superficial temporary artery biopsy
58
cure for temporal arteritis
prednisone within 1st weeks of onset!! | typically 60 mg per day then gradually and slowly dec over mo