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Neuro > Headache > Flashcards

Headache Flashcards

1
Q

List some of the red flag symptoms

A 
first/worst
abrupt onset
fundamental pattern change
new headache & 50 yo
cancer, HIV, pregnancy
abnormal physical exam
neuro sx <1hr later
headache onset w/seizure or syncope, w/ exertion, sex or valsalva
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2
Q

List some of the comfort signs

A 
stable pattern
long-standing history
family history of similar headahces
normal physical exam
consistently triggered by: hormonal cycle, specific foods, specific sensory input (light, odors), weather changes
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3
Q

Which type of headache is more common: primary or secondary?

A

primary

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4
Q

What are the 3 major types of primary headache?

A

migraine
cluster
tension-type

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5
Q

What are some causes of secondary headache?

A 
Trauma
Vascular 
infection
metabloism
oncologic
inflammatory
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6
Q

What are the pain sensitive intracranial structures?

A

meningeal arteries
proximal portions of the cerebral arteries
dura at the base of the brain
venous sinuses
cranial nerves 5,7,9, 10 and cervical nerves 1,2, and 3

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7
Q

Which pain sensitive intracranial structures are innervated by V1?

A

meningeal arteries
proximal portions of the cerebral arteries
dura at the base of the brain
venous sinuses

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8
Q

When is imaging obtained for headache?

A

recurrent migraine with recent change in headache pattern, new onset seizures or focal neurologic signs or symptoms

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9
Q

What are common times of year for patients to expereince cluster headaches?

A

around the summer & winter solstices

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10
Q

What are the diagnostic criteria for cluster headache?

A

1/every other day to 8/day
must be: severe, unilateral oribtal/supraorbital and or/temporal location and last 15-180 minutes
plus have 1 of the following: conjunctival injection, lacrimation, rhinorrhea, nasal congestion, forehead and facial sweating, miosis, ptosis, eyelid edema

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11
Q

Can horner’s syndrome occur in a cluster headache?

A

yes

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12
Q

What are the diagnostic criteria for migraine?

A

headache attack last 4-72hrs
two of the following: unilateral, pulsating, moderate-severe intensity, aggravation by walking up stairs
one of the following: nausea, vomiting, photophobia and phonophobia

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13
Q

What are the 3 best predictors of diagnosis of migraine?

A

nausea, disability and photophobia

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14
Q

When do migraine aura’s usually occur?

A

~20 min before migraine

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15
Q

What are the diagnostic criteria for tension-type headache?

A

headache last hours or is continuous
two of the following: pressing/tightening quality (nonpulsating), mild/mod intensity, bilateral, no aggravation by walking up stairs/physical activity
no more than one of: photophobia, phonophobia, mild nausea, meither moderate or severe nausea nor vomiting

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16
Q

How high does pressure have to become in the sinuses to cause headache?

A

> 180mm Hg

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17
Q

What are not readily modifable risk factors for chronic daily headache?

A 
migraine
female sex
low education
low socioeconomic status
head injury
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18
Q

What are readily modifiable risk factors for chronic daily headache?

A 
attack frequency
obesity
medication overuse
stressful life events
snoring
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19
Q

What role does the trigeminovascular system play in migraine?

A

can generate or perpetuate pain

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20
Q

How can cortical neuronal hyperexcitability occur?

A 
enhanced release of excitatory neurotransmitters
-elevated plasma glutamate concentration
-identified genetic mutations in FHM
reduced intracortical inhibition
low brain Mg2+
altered brain energy metabolism
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21
Q

What is cortical spreading depression?

A

wave of intense cortical neuron activity folowed b neuronal suppression (inc rCBF –> dec rCBF)
supp. often coincies with headache onset

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22
Q

How fast does CSD travel?

A

2-3mm/min

23
Q

What is released during CSD that can lead to pain? (leaks out of neurons)

A

AA
NO
H+
K+

24
Q

How does brainstem dysfunction contribute to initiating migraine?

A

dysfunction in areas involved in central control of nocicdption (PAG focal point)
facilitates activation and sensitization of TNC neurons?

25
Q

What AA is serotonin derived from?

A

tryptophan

26
Q

How is synthesis of serotonin limited in the brain?

A

by concentration of tryptophan in the brain (requires O2 and pteridine cofactor)

27
Q

How is synthesis of serotonin limited in the gut?

A

by tryptophan hydroxylase (rate limiting enzyme)

28
Q

How is serotonin metabolized?

A

converted to 5-hydroxyindole acetic acid by MAO

29
Q

How is serotonin action terminated?

A

SERT uptakes serotonin, the converted by MAO

30
Q

What does the pineal gland convert serotonin to?

A

melatonin

31
Q

Where is the majority of serotonin located in the body?

A

gi tract

32
Q

Where in the CNS is the most serotonin found?

A

midbrain raphe nucleus

projects to: hypothalamus, neostriatum, limbic forebrain, neocortex, medulla, spinal cord

33
Q

What type of receptor is the 5-HT 3 receptor?

A

ligand gated cation channel

34
Q

What kind of receptor is 5-HT1A-E?

A

inhibits adenylated cyclase, also opens K+ channel

35
Q

What does the 5-HT2A-C receptor do?

A

PI hydrolysis

36
Q

What do the 5-HT4-7 receptors do?

A

activate adenylate cyclase or unknown

37
Q

What are the serotonin autoreceptors? What is their function?

A

1A and 1D like

decrease serotonin release

38
Q

What are the effects of serotonin on the CV system?

A

potent vasoconstriction in large arteries/veins; cranial blood vessels (via 5-HT1D)
vasodilation in coronary, sk musc and cutaneous blood vessels
Bezold-Jarisch reflex (coronary chemoreceptors—>bradycardia, hypotension and hypoventilation)
platelet aggrevation—>active uptake of serotonin from circulation

39
Q

What neuotransmitter activities is serotonin involved in?

A 
sensory perception
slow wave deep sleep
temperature regulation
neuroendocrine regulation-ACTH, GH, prolactin, TSH, FSH, LH
learning and memory, esp short-term
pain perception
drug abuse
40
Q

What does phenelzine treat?

A

depression

41
Q

What does Odansetron treat?

A

nausea and vomiting

42
Q

What does fluoxetine treat?

A

depression

43
Q

What does cyproheptadine treat?

A

itch

44
Q

What does buspirone treat?

A

anxiety

5-HT1A receptor partial agonist

45
Q

What does tegaserod treat?

A

Constipation predominant IBS

46
Q

How does LSD (lysergic acid diethylamide) affect the serotonin system?

A

relatively non specific, acts on 5-HT2 receptors

potent hallucinogen

47
Q

What is the action of sumatriptan?

A

5-HT1B/D receptor agonist on cerebral blood vessels

used to treat migraines, stops existing ones

48
Q

What is the major class of drug used to stop an existing migraine? How do they work?

A 
triptans
5-HT1B/D receptor agonist
inhibit release of vasoactive peptides (CGRP)
promote vasoconstriction
block brainstem pain pathways
inhibit trigeminal nucleus caudalis
49
Q

What groups of drugs serve as alternatives to triptans for stopping a migraine?

A

ergots
steroids
NSAIDS w/caffiene

50
Q

What are common side effects of triptans?

A 
peripheral vasoconstriction
N/V
angina
dizziness
flushing
51
Q

What are contraindicators for triptans?

A

stroke and recent MI

uncontrolled HTN and Ischemic heart disease

52
Q

What triptans are also used for migraine prevention due to their long half life?

A

Frovatriptan

Naratriptan

53
Q

Why is butalbital w/caffeine and acetaminophen a bad choice for stopping a migraine?

A

high abuse potential

54
Q

What are some classes of drugs used for prevention of migraine?

A

tricyclic antidepressants
antiseizure agents
-divalproex sodium, valproic acid, topiramate, gabapentin, pregabalin, lamotrigene
vasoactive agents
-beta blockers, calcium channel blockers (less effective)

Neuro (14 decks)

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