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🧠📖💯 > Headache > Flashcards

Headache Flashcards

1
Q

What are the pain-sensitive structures of the cranium?

A
  1. Skull (SPAM) - skin, periosteum, arteries, muscles
    skin, muscles, extracranial arteries, external periosteum
  2. EEN, sinuses
  3. Veins, Arteries (SIMV)
    a. Intradural - proximal ACA, MCA, intracranial ICA
    b. Middle meningeal
    c. Superficial temporal arteries
    d. Venous sinuses
  4. Nerves
    a. C1-C3
    b. CNs passing through the dura
  5. Parts of the dura at the base of the brain

SAVE Nerves Dura
Skull Arteries Veins EEN Nerves Dura

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2
Q

MOA of sumatriptan?

A

5-HT1D receptor agonist

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3
Q

Medication overuse headache occurs

____ days / month
Overuse for at least ____ months

A

15 days/month

Overuse for at least 3 months

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4
Q

Treatment of Cluster Headache

A

Oxygen by nonrebreather

Sumatriptan

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5
Q

Treatment of Hemicrania Continua

A

Indomethacin

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6
Q

Treatment of Paroxysmal Hemicrania

A

Indomethacin

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7
Q

Treatment of SUNA/SUNCT

A

Lamotrigine

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8
Q

Most commonly involved CNV parts (V1-V3) in Trigeminal Neuralgia?

A

V2-V3

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9
Q

Treatment of primary cough headache?

A

Indomethacin

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10
Q

Thunderclap headache reaches maximal intensity within ____

A

1 minute

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11
Q

New daily persistent headache becomes continuous and unremitting within ____ and lasts for longer than ____

A

24 hours

3 months

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12
Q

Pain from a non-noxious stimulus

A

Allodynia

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13
Q

Burning pain occurring after peripheral nerve injury

A

Causalgia

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14
Q

Unpleasant sensations

A

Dysesthesia

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15
Q

Pain from a noxious stimuli that is significantly greater than expected

A

Hyperalgesia

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16
Q

Delayed, increased pain from a noxious stimulus

A

Hyperpathia

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17
Q

C fibers

Release what?
Enter SC where?

A

Release Substance P

Enter Lamina II

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18
Q

AD fibers

Release what?
Enter SC where?

A

Release Glutamate, Aspartate, ATP
(transmit pain through)

Enter Laminae I, II, V

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19
Q

2 types of regional pain syndrome

A

Type I - reflex sympathetic dystrophy (MC)
- minor limb injury > CNS

Type II - causalgia

  • peripheral nerve injury
  • focal deficits
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20
Q

Pain from disease in extracranial parts of the body is not referred to the head, EXCEPT for (2)

A

1) ICA, cervical portion -> eyebrow, supraorbital

2) Cervical spine (upper) -> occiput

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21
Q

Expanding pcomm or distal ICA aneurysms will produce pain where?

A

Eye

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22
Q

Pain worse when patient is upright, subsides upon awakening

A) Frontal, ethmoidal
B) Maxillary, sphenoidal
C) Frontal, sphenoidal
D) Maxillary, ethmoidal

A

B) Maxillary, Sphenoidal - subsides upon awakening, worse upright

Frontal, Ethmoidal - worse upon awakening, subsides when upright

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23
Q

Symptomatic treatment of sinus headache

A

Phenylephrine

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24
Q

Which is the least likely cause of headache?

A) Hypermetropia
B) Myopia
C) Astigmatism
D) Acute angle closure glaucoma

A

B) Myopia

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25
Q

Treatment of LP or low CSF pressure HA

A

Epidural blood patch

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26
Q

True or false. Jugular venous compression relieves LP or low CSF pressure HA

A

FALSE. Jugular venous compression WORSENS the headache.

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27
Q

What is the classic/neurologic migraine?

Migraine w/ aura or without aura?

A

Migraine WITH aura = CLASSIC

WITH = CLASSIC
WITHOUT = COMMON
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28
Q

What is the most common migraine aura?

A

Visual

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29
Q

Which is more common?

Migraine w/ aura or without aura?

A

Migraine WITHOUT aura is more COMMON

WITH = CLASSIC
WITHOUT = COMMON
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30
Q

What is usual onset of migraine? (age)

A

Young adult
< 30 years old (80%)

In pregnancy: 1st trim

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31
Q

Which of the following is NOT associated with migraine?

A) Chocolate, cheese
B) Fatty food
C) Oranges
D) Tomatoes
E) Onions
F) Tyramine
G) White wine
H) Caffeine
I) None (all are associated w/ migraine)
A

G) White wine

-Red wine or port wine are a/w migraine

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32
Q 
Which of the following is NOT associated with migraine?
A) Glare
B) Infantile colic
C) Motion sickness
D) Episodic abdominal pain
E) Alcohol sensitivity
F) Fainting
G) Exercise-induced headaches
H) Sinus headaches
I) Tension Headaches
J) Menstrual headaches
K) None (all are associated w/ migraine)
A

K) None (all are associated w/ migraine)

pls study hehe

33
Q

Which of the following is NOT true of migrainous vertigo?

A) Varying degrees and types of dizziness
B) Disturbed by highly patterned or crowded visual environments
C) Mainly in adults
D) Episodic occurrence w/ interspersed attacks of migraine

A

C) Mainly in adults

More common in children

34
Q

Which CN is usually affected in Ophthalmoplegic migraine?

A

CN III (w/ ptosis)

35
Q

Genetic abnormality implicated in Familial Hemiplegic Migraine?

A

CACNA1A (P/Q type Ca channel a subunit)

ATP1A2 (Na/K ATPase channel)

36
Q

Which genetic abnormality in Familial Hemiplegic Migraine has overlap with other diseases? What are those diseases?

A

CACNA1A

FHM
Acetazolamide-Responsive Ataxia
CADASIL

37
Q

Which of the following is TRUE of Status Migrainosus?

A) Lasts > 24 hours
B) Sometimes follows head injury or viral infection
C) Initially bilateral, generalized
D) Nausea and vomiting are prominent late symptoms
E) Triptans are useful at this stage

A

True: B) Sometimes follows head injury or viral infection

  • Lasts > 72 hours
  • Unilateral -> bilateral, generalized
  • Nausea and vomiting are prominent EARLY symptoms
  • Triptans are NOT useful at this stage
38
Q

Which of the following is TRUE of migraine-associated TIA or Stroke?

A) Common with brief, severe auras
B) Occur in the anterior circulation
C) More common in migraine with aura
D) More common in men

A

C) More common in migraine WITH aura

Common with PROLONGED auras
Occur in the POSTERIOR circulation
More common in WOMEN

39
Q

Which of the following is NOT true of migraine pathogenesis?

A) During an aura, there is a reduction in posterior cortical blood flow
B) Cortical impairment in spreading oligemia occurs at 2-3mm/min and does not respect arterial boundaries
C) CNV’s unmyelinated fibers subserve both pain and autonomic functions
D) Substance P and CGRP are released to sensitize the trigeminal system to the pulsatility of vessels and increase their permeability
E) Serotonin acts as a humoral mediator in the neural and vascular components and is released from platelets at the peak of the headache
F) Nitric oxide is implicated as the cause of pain

A

E) Serotonin acts as a humoral mediator in the neural and vascular components and is released from platelets at the ONSET of the headache

40
Q

Alpha-adrenergic agonist with strong serotonin receptor affinity & vasoconstrictive action

Repeat use is not advised

Caffeine may potentiate effects

A) Triptans
B) DHE
C) NSAIDs
D) Indomethacin

A

B) DHE

41
Q

Which of the following is NOT true regarding migraine treatment?

A) Metoclopromide + DHE may be used in severely ill patients with prolonged headache
B) Ergots and triptans are contraindicated in pts w/ poorly-controlled hypertension
C) Ergotamine or serotonin agonists can cause RCVS
D) Serotonin agonists or ergots can be used for ongoing and prolonged aura of any type
E) CGRP antagonists are associated with liver toxicity

A

D) Serotonin agonists or ergots can be used for ongoing and prolonged aura of any type

  • should be avoided for ongoing and prolonged aura of any type
42
Q

Which migraine prophylactic medication is useful in perimenstrual migraine?

A

Cyproheptadine

43
Q

What is the known complication of Methysergide?

A

Retroperitoneal and pulmonary fibroses

44
Q

What are the indomethacin-responsive headaches?

A

Valsalva-related HA
Trigeminal-autonomic cephalagias
Stabbing HAs

45
Q

Epidemiology of Cluster headaches?

A

Adult men

Age 20-50

46
Q

Which is TRUE of cluster headache symptomatology?

A) Pain is supraorbital
B) Severe paroxysmal unilateral orbital localization
C) Intense, throbbing
D) Nightly recurrence
E) Both orbits are involved individually at different times

A

TRUE: D) Nightly recurrence

  • Pain is deep and AROUND the eye
  • Severe CONSISTENT unilateral orbital localization
  • Intense, NON-throbbing
  • Almost always the SAME ORBIT is involved
47
Q

As to duration of pain, differentiate

A) Cluster
B) CPH
C) SUNCT

A

Cluster 45 mins (15-180)

CPH 2-45 mins

SUNCT < 4 mins

48
Q

Which is more common in women?

A) Cluster
B) Chronic Paroxysmal Hemicrania
C) SUNCT
D) None of the above

A

Ans: B) Chronic Paroxysmal Hemicrania

Cluster - MC in men

49
Q

Which is the “most common variety of headache”?

A

Tension-Type Headache

50
Q

Which of the following is TRUE of Tension-Type headache?

A) More common in men
B) More likely to arise in young adulthood
C) Consistently dull without any superimposed aching pain
D) Due to nitric oxide
E) Cannot present with mild fluctuations
F) Interferes with daily activities

A

D) Due to nitric oxide

More common in WOMEN
More likely to arise in MIDDLE AGE
Dull with WAVES of aching pain SUPERIMPOSED
May persist WITH mild FLUCTUATIONS
DOES NOT seriously INTERFERE with daily activities

51
Q

True or false: Hemicrania continua is accompanied by autonomic features

A

True

52
Q

Which of the following is TRUE of new daily persistent headache?

A) Daily recurrent bouts of generalized headache
B) Gradual onset
C) Unilateral, with autonomic features
D) More common in men
E) Can follow a viral illness, stressful situation, non-cranial surgery

A

E) Can follow a viral illness, stressful situation, non-cranial surgery

  • UNREMITTING generalized headache
  • Distinct and fairly RAPID onset
  • NO laterality, WITHOUT autonomic features
  • More common in women
53
Q

Which of the following is more common in MEN?

A) Cluster
B) Chronic Paroxysmal Hemicrania
C) Tension-Type Headache
D) New Daily Persistent Headache

A

A) Cluster

54
Q

Which of the following is TRUE of Hypnic HA?

A) Occurs only at night
B) Unilateral
C) No autonomic signs
D) Can be treated with lithium & indomethacin

A

True: D) Can be treated with lithium & indomethacin

  • Can occur w/ DAYTIME naps
  • Bilateral
  • (+) Lacrimation, rhinorrhea
55
Q

Most common cause of generalized persistent headache in adolescents and adults

A

Mild depression/anxiety

56
Q

Sensation of having a nail driven into head

A

Clavus hystericus

57
Q

Headaches present in what fraction of brain tumor cases?

A

1/3 of cases

58
Q

Per adams, this type of brain tumor is frequently associated with headache

A

Colloid cysts

59
Q

Paroxysmal headaches described as severe HA peaking in a few seconds and subsiding within 1 hour are typical in this type of brain tumor

A

Colloid cyst of the 3rd ventricle

60
Q

Usual age at onset of Temporal Arteritis

A

55 years old

61
Q

Which among the following are more sensitive tests for GCA?

A) ESR
B) CRP
C) Arteriography of ECA Branches
D) B&C

A

D) B&C

62
Q

Headache of pseudotumor cerebri is worsened by standing/supine position.

A

Supine

63
Q

For low-pressure and spinal puncture headache:

Characteristic MRI finding?
Treatment?

A

Pachymeningeal enhancement

Caffeine (IV)

64
Q

For migraines in pregnancy, what are the appropriate therapeutic options:

A) Prophylaxis
B) Contraindicated
C) Status Migrainosus

A

A) Prophylaxis - B-adrenergics, TCAs

B) Contraindicated - Ergots

C) Status Migrainosus - Mg, Metoclopromide

65
Q

Which type of Chiari Malformation can cause headaches?

A) Type I
B) Type II
C) Type III
D) Type IV

A

A) Type I - cerebellum through FM

Review
Type II (MC) - cerebellum + bs through FM * + spina bifida
Type III (most serious) - cerebellum + bs into SC
Type IV - undeveloped cerebellum * + exposed parts of skull & SC

66
Q

What are the causes of thunderclap headache

A

Vascular
- SAH (a and n-a, perimesencephalic), CVT, RCVS

Medical

  • Pituitary apoplexy
  • Hypertension (accelerated)

Primary
- Migraine

Meds
- Cocaine, adrenergics

67
Q

What is a “symptomatic” trigeminal neuralgia?

A

A/w presence of other disease:

MS, basilar aneurysm, CPA tumor

68
Q

Which of the following is not part of the recommended treatment options for Trigeminal Neuralgia?

A) Phenytoin
B) Gabapentin, pregabalin
C) Phenobarbital
D) Valproic Acid
E) Baclofen
A

C) Phenobarbital

Tx options:
CBZ, Phenytoin, Gaba/pregab, VA, Baclofen

69
Q

Nerve implicated in Glossopharyngeal Neuralgia?

A

Vagus n, auricular branch

70
Q

Which craniofacial neuralgia may be accompanied by bradycardia and by syncope?

A

Glossopharyngeal Neuralgia

71
Q

Glossopharyngeal neuralgia is most commonly provoked by

A) Talking
B) Chewing
C) Swallowing
D) Yawning
E) Laughing
A

C) Swallowing

The rest are also triggers

72
Q

Cranial Herpes Zoster involves which branch of the trigeminal nerve?

A

V1

73
Q

Which type of headache is associated with neck injuries?

A) Trochlear HA
B) Occipital neuralgia
C) Third occipital nerve HA
D) All of the above

A

C) Third occipital nerve HA

- C2, C3 facet joint arthropathy -> impinged branch of C3 dorsal ramus (3rd occipital nergve)

74
Q

What is the treatment for Costen Syndrome?

A

TMJ Pain

Tx: Amitriptyline

75
Q

Provoking factor for cluster headache

A

Alcohol

76
Q

Which type of migraine presents with sensitivity of the scalp?

With aura / without aura

A

With aura

77
Q

Which migraine usually has (+) family history?

With aura / without aura

A

WITH aura

78
Q

True or false. HAs a/w brain tumors are usually worse at night

A

False. Worse in early AM

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