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
Treatment of LP or low CSF pressure HA
Epidural blood patch
26
True or false. Jugular venous compression relieves LP or low CSF pressure HA
FALSE. Jugular venous compression WORSENS the headache.
27
What is the classic/neurologic migraine? Migraine w/ aura or without aura?
Migraine WITH aura = CLASSIC ``` WITH = CLASSIC WITHOUT = COMMON ```
28
What is the most common migraine aura?
Visual
29
Which is more common? Migraine w/ aura or without aura?
Migraine WITHOUT aura is more COMMON ``` WITH = CLASSIC WITHOUT = COMMON ```
30
What is usual onset of migraine? (age)
Young adult < 30 years old (80%) In pregnancy: 1st trim
31
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) ```
G) White wine -Red wine or port wine are a/w migraine
32
``` 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) ```
K) None (all are associated w/ migraine) | pls study hehe
33
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
C) Mainly in adults More common in children
34
Which CN is usually affected in Ophthalmoplegic migraine?
CN III (w/ ptosis)
35
Genetic abnormality implicated in Familial Hemiplegic Migraine?
CACNA1A (P/Q type Ca channel a subunit) ATP1A2 (Na/K ATPase channel)
36
Which genetic abnormality in Familial Hemiplegic Migraine has overlap with other diseases? What are those diseases?
CACNA1A FHM Acetazolamide-Responsive Ataxia CADASIL
37
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
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
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
C) More common in migraine WITH aura Common with PROLONGED auras Occur in the POSTERIOR circulation More common in WOMEN
39
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
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
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
B) DHE
41
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
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
Which migraine prophylactic medication is useful in perimenstrual migraine?
Cyproheptadine
43
What is the known complication of Methysergide?
Retroperitoneal and pulmonary fibroses
44
What are the indomethacin-responsive headaches?
Valsalva-related HA Trigeminal-autonomic cephalagias Stabbing HAs
45
Epidemiology of Cluster headaches?
Adult men Age 20-50
46
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
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
As to duration of pain, differentiate A) Cluster B) CPH C) SUNCT
Cluster 45 mins (15-180) CPH 2-45 mins SUNCT < 4 mins
48
Which is more common in women? A) Cluster B) Chronic Paroxysmal Hemicrania C) SUNCT D) None of the above
Ans: B) Chronic Paroxysmal Hemicrania Cluster - MC in men
49
Which is the β€œmost common variety of headache”?
Tension-Type Headache
50
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
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
True or false: Hemicrania continua is accompanied by autonomic features
True
52
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
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
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) Cluster
54
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
True: D) Can be treated with lithium & indomethacin * Can occur w/ DAYTIME naps * Bilateral * (+) Lacrimation, rhinorrhea
55
Most common cause of generalized persistent headache in adolescents and adults
Mild depression/anxiety
56
Sensation of having a nail driven into head
Clavus hystericus
57
Headaches present in what fraction of brain tumor cases?
1/3 of cases
58
Per adams, this type of brain tumor is frequently associated with headache
Colloid cysts
59
Paroxysmal headaches described as severe HA peaking in a few seconds and subsiding within 1 hour are typical in this type of brain tumor
Colloid cyst of the 3rd ventricle
60
Usual age at onset of Temporal Arteritis
55 years old
61
Which among the following are more sensitive tests for GCA? A) ESR B) CRP C) Arteriography of ECA Branches D) B&C
D) B&C
62
Headache of pseudotumor cerebri is worsened by standing/supine position.
Supine
63
For low-pressure and spinal puncture headache: Characteristic MRI finding? Treatment?
Pachymeningeal enhancement Caffeine (IV)
64
For migraines in pregnancy, what are the appropriate therapeutic options: A) Prophylaxis B) Contraindicated C) Status Migrainosus
A) Prophylaxis - B-adrenergics, TCAs B) Contraindicated - Ergots C) Status Migrainosus - Mg, Metoclopromide
65
Which type of Chiari Malformation can cause headaches? A) Type I B) Type II C) Type III D) Type IV
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
What are the causes of thunderclap headache
Vascular - SAH (a and n-a, perimesencephalic), CVT, RCVS Medical - Pituitary apoplexy - Hypertension (accelerated) Primary - Migraine Meds - Cocaine, adrenergics
67
What is a β€œsymptomatic” trigeminal neuralgia?
A/w presence of other disease: | MS, basilar aneurysm, CPA tumor
68
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 ```
C) Phenobarbital Tx options: CBZ, Phenytoin, Gaba/pregab, VA, Baclofen
69
Nerve implicated in Glossopharyngeal Neuralgia?
Vagus n, auricular branch
70
Which craniofacial neuralgia may be accompanied by bradycardia and by syncope?
Glossopharyngeal Neuralgia
71
Glossopharyngeal neuralgia is most commonly provoked by ``` A) Talking B) Chewing C) Swallowing D) Yawning E) Laughing ```
C) Swallowing The rest are also triggers
72
Cranial Herpes Zoster involves which branch of the trigeminal nerve?
V1
73
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
C) Third occipital nerve HA | - C2, C3 facet joint arthropathy -> impinged branch of C3 dorsal ramus (3rd occipital nergve)
74
What is the treatment for Costen Syndrome?
TMJ Pain Tx: Amitriptyline
75
Provoking factor for cluster headache
Alcohol
76
Which type of migraine presents with sensitivity of the scalp? With aura / without aura
With aura
77
Which migraine usually has (+) family history? With aura / without aura
WITH aura
78
True or false. HAs a/w brain tumors are usually worse at night
False. Worse in early AM