Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

6a > Headache > Flashcards

Headache Flashcards

1
Q

Primary headache

A

migraine (episodic, chronic)
tension type
trigeminal autonomic cephalgia (TACs) - e.g. cluster headaches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Secondary headache

A 
headache and neck trauma
extra-cranial
vascular disease
tumour
infection
abnormal CSF pressure: hyper/hypotension
drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Episodic migraine headache characteristics

A 
2 of:
unilateral location
throbbing quality
worse with exertion
moderate to severe intensity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Episodic migraine associated symptoms

A

1 of:

  • nausea/vomiting
  • stimulus sensitivity (light, sound, normally pleasant smells)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Episodic migraine headache diagnosis

A

2 characteristics + 1 associated symptom
5 attacks with 1 year history + normal exam
–> migraine without aura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Migraine with aura - visual symptoms

A 
scintillations
peripheral field loss
photopsia
central scotoma
zigzag areas surrounding an area of gradual visual loss
highly specific, short-lived symptoms
~20% of patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Migraine with aura - nonvisual symptoms

A

common: sensory, cognitive
rare: motor, basilar, retinal (blind in 1 eye)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Migraine with aura - clinical findings

A

Gradual onset of one or more reversible symptoms
Symptoms develop over > 4 minutes, or in succession
Duration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Triggers of migraines

A 
menstrual periods
alcohol/foods
weather change
oversleeping
exposure to odours
let down period of stress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Chronic migraine diagnosis

A

Headache >15 days/month
Average headache > 4 hours
Headaches meet criteria for migraine > 8 days/month
With/without medication overuse (> 10 days/month for over 3 months)
primary disorder of the brain
often occurs after repeated attacks of episodic migraine
disorder of cortical hyperexcitability and dysfunctional brainstem pain modulating centres

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Migraine progression

A

often gradual, months-years
neither inexorable/irreversible
happens in ~3% of episodic migraine sufferers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Prevalence of chronic migraine

A 
2% of population
5x higher in women
80% of cases seen in a headache specialty clinic are CM
2.5% of EM will progress to CM in a year
50% are overusing medications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Episodic tension-type headache

A 
"mild migraine"/entry point to migraine
Generalized, nonpulsating pressure
mild-moderate intensity
No aggrevation with activity
No nausea/vomiting
Photophobia/sonophobia absent (or only 1 present)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

sinus headache

A

recurrent frontal headache
nasal stuffiness/obstruction
meets criteria for migraine (>95% of “sinus headache” are migraine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Trigeminal autonomic cephalgias (TACs)

A 
cluster headache
ice-pick
cough
coital
benign exertional
chronic paroxysmal hemicrania
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cluster headache characteristics

A

Severe unilateral orbital pain

short duration, 2 weeks without an attack

17
Q

Cluster headache associated autonomic symptoms

A 
Unilateral
Conjunctival injection
tearing
rhinorrhea/nasal congestion
ptosis/miosis: rare
18
Q

Migraine pathophysiology

A

brainstem/occipital cortex
Cortical spreading depression
- wave of intense cortical neuron activity followed by neuronal suppression
- velocity 2-3 mm/min
- probably underlines visual aura
- possibly occurs in clinically silent areas of cortex (migraines without aura)

19
Q

Primary cause of migraine headache

A

Hyperexcitable cortex

Dysmodulated brain - activation in dorsal pons

20
Q

Non-pharmacologic acute therapy of migraines

A

cold (decrease v/d)
pressure
rest - dark/quiet atmosphere

21
Q

Migraine symptomatic acute therapy

A 
simple analgesics
NSAIDs
combination analgesics
Opioids
Acetaminophen not really too effective
22
Q

Specific agents for migraine symptoms

A

Ergotamine: first drug released, therapeutic gain is awful
Dihydroergotamine: much less vasoactive, important use in iv line in hospitals
Triptans

23
Q

Triptans

A 
Sumatriptan: highly effective and relatively safe; multiple modes of administration
naratriptan
zomitriptan
rizatriptan
almotriptan
electriptan
frovotriptan
24
Q

Triptan MOA

A

Decreased transmission through trigeminovascular system
Vasoconstriction
Modulation at trigeminal nucleus caudalis

25
Q

Triptan clinical considerations

A

No triptan is shown to be clinically superior to another
choose based on patient preference
safe to use with SSRIs
assess efficacy/side effects regularly
Switch triptans to achieve optimal results
Consider adjunctive therapy with NSAIDs (naproxen), anti-emetic (metoclopramide)

26
Q

Rapid onset attack therapy (early peak)

A 
almotriptan
eletriptan
rizatriptan
sumatriptan
zolmitriptan
27
Q

Slow onset/recurrence: late peak therapy

A

naratriptan

frovatriptan

28
Q

Nocturnal onset migraine therapy

A

zolmitriptan/rizatriptan wafers

29
Q

Nausea/vomiting migraine therapy

A

sumatriptan/zomitriptan nasal spray

sumatriptan injectible

30
Q

Side effect-sensitive patient migraine therapy

A

almotriptan/naratriptan/frovatriptan

31
Q

Acute treatment of migraine steps

A

Mild: ASA/caffeine, 10 mg metoclopramide
30-45 min: 100 mg sumtriptan (moderate headache)
2 hours: 30 mg codeine/caffeine/acetaminophen

32
Q

Migraine prophylaxis

A 
Individualized
assess overall impact
failure to control with acute agents
sequential use of available agents
use adequate dose and duration of therapy
33
Q

Non-pharmacologic migraine prophylaxis

A

relaxation training
biofeedback
CBT
not covered!!

34
Q

Pharmacologic migraine prophylaxis

A

B-blockers: propranolol, nadolol
TCA: amitriptyline
Ca channel blockers: flunarizine (makes you fat/depressed)
serotonergic agents: pizotifen
Anti-convulsants:
Neurotoxin - studied for chronic migraines (botox)

35
Q

Cluster headache treatment

A

aggressive approach
start preventative drug +/- steroids
acute agents for breakthrough headaches
treat until 2 weeks headache-free, or usual duration of patient’s cluster

36
Q

Cluster headache acute therapy

A

Gold standard: Sumatriptan intra-nasal/subcutaneous

ergotamine tartrate
DHE intra-nasal/subcut
Oxygen inhalation (10-12L/minute)
37
Q

Cluster headache preventative therapy

A 
Verapamil
Prednisone (transitional)
topiramate
lithium
divalproex
38
Q

Chronic migraine treatment

A

avoidance of aggravators
triptans
biobehavioural
Prophylaxis (topiramate, botox)

39
Q

Botox MOA in CM

A

when used for prophylaxis of headache in adults with chronic migraine, acts as inhibitor of NTs associated with genesis of pain
Presumed mechanism: blocking peripheral signals to CNS –> inhibits central sensitization

6a (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions