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aNeuro Exam 2- Lindsey's > Headache > Flashcards

Headache Flashcards

1
Q

Name 2 common triggers of cluster headaches.

A
  1. EtOH
  2. drugs w/ vasodilator properties
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2
Q

Name 4 general types of migraine prophylactic drugs.

A
  1. beta blockers
  2. calcium channel blockers
  3. tricyclic antidepressants
  4. anti-epileptics
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3
Q

Name the BVs in the cranium that carry pain fibers.

A
  • dural veins or sinuses
  • meningeal arteries
  • extracranial and proximal intracranial arteries
  • extracranial veins
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4
Q

Name 6 general types of migraine abortive meds.

A
  1. aspirin
  2. acetaminophen
  3. NSAIDs
  4. ^^ med combos (+ caffeine, etc)
  5. SSRAs - selective
  6. SSRAs - nonselective
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5
Q

What are 3 abortive txs for tension headache?

A
  1. aspirin
  2. acetaminophen
  3. NSAIDs
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6
Q

What is the premonitory phase of a migraine?

A

alterations in mood, alertness, and/or appetite up to 24 hours before the HA

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7
Q

Who is 4x more likely to get cluster headaches?

A

men

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8
Q

What are 4 prophylactic treatments for tension headache?

A
  1. tricyclic antidepressants
  2. SSRIs (Prozac)
  3. psychotherapy
  4. PT
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9
Q

What are the most common and health-threatening conditions that underly secondary headaches?

A
  • meningitis
  • hemorrhage
  • intracranial HTN
  • giant cell arteritis
  • traumatic head injury
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10
Q

At what age does giant cell arteritis present?

A

80s-90s

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11
Q

Who is 9x more likely to get ICP?

A

women

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12
Q

These are neuro symptoms preceding a HA (99% visual)

  • must be visual, sensory, language, motor, brainstem, or retinal changes AND at least 2 of:
    • unilateral symptoms
    • gradual devel over 5+ mins lasts 5-60 mins
    • accompanied or followed by migraine
    • ***30% of pts experience these
A

the aura phase of a migraine

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13
Q

Name some migraine triggers.

A
  • missed meals
  • lack of adequate sleep
  • EtOH
  • caffeine withdrawal
  • PMS
  • “relief of stress”
  • certain foods (MSG, nitrtes, tyramine)
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14
Q

What tests and results diagnose giant cell arteritis?

A
  • elevated ESR
  • elevated CRP
  • positive temporal artery biopsy
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15
Q

What is the name of the lesser intensity HA due to a small hemorrhage that heralds a subsequent massive hemorrhage?

A

a sentinel HA

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16
Q

What are the s/s of giant cell arteritis?

A
  • jaw claudication
  • temporal artery region scalp tenderness
  • blindness
  • joint pain
  • constitutional symptoms
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17
Q

This is the post-event exhaustion and lethargy in a migraine.

A

the resolution phase

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18
Q

Before or simultaneously with the onset of _____ symptoms, regional cerebral blood flow is decreased in the cortex corresponding to the clinically affected area or wider.

A

aura

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19
Q

Before or simultaneously with the onset of aura symptoms, ______ is decreased in the cortex corresponding to the clinically affected area or wider.

A

regional cerebral blood flow

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20
Q

This is caused by sensory stim of a particular area w/in the trigeminal sensory innervation.

A

trigeminal neuralgia

21
Q

What is the aura phase of a migraine?

A
  • neuro symptoms preceding a HA (99% visual)
  • must be visual, sensory, language, motor, brainstem, or retinal changes AND at least 2 of:
    • unilateral symptoms
    • gradual devel over 5+ mins
    • lasts 5-60 mins
    • accompanied or followed by migraine
    • ***30% of pts experience these***
22
Q

What is a secondary headache?

A
  • associated with underlying conditions or systemic pathology
  • constant
  • 10% of all headaches
23
Q

DX?

  • at least 10 episodes of HA that last 30 mins to 7 days
  • at least 2 of the following:
    • pressing or tightening sensation
    • mild to moderate severity
    • bilateral
    • not aggravated by phys activity
    • NO nausea/vomiting
    • EITHER photophobia OR phonophobia
A

tension headache

24
Q

Name 3 basic structures that carry pain fibers in the cranium.

A
  1. the meninges
  2. certain BVs
  3. the dermis
25
Q

What is a primary headache?

A
  • no known cause
  • 90% of all headaches
  • chronic or episodic
  • can be tension, migraine, or trigeminal autonomic cephalagias
26
Q

Dx?

  • jaw claudication
  • temporal artery region scalp tenderness
  • blindness
  • joint pain
  • constitutional symptoms
A

giant cell arteritis

27
Q

What is the resolution phase of a migraine?

A

the post-event exhaustion and lethargy

28
Q

Name 3 causes of subarachnoid hemorrhage (SAH).

A
  1. trauma
  2. ruptured aneurism
  3. AV malformation
29
Q

Name 5 alternative/non-pharm treatments for migraines.

A
  1. supplements (Mg, B2, Butterbur)
  2. sleep
  3. acupuncture
  4. botox
  5. biofeedback
30
Q

Name 6 abortive txs for cluster headaches.

A
  1. O2
  2. triptans
  3. ergotamine derivatives
  4. lidocaine
  5. corticosteroids
  6. nerve blocks
31
Q

What are the 4 phases of a migraine attack?

A
  1. premonitory
  2. aura
  3. HA and assoc symptoms
  4. resolution
32
Q

What are the 3 prophylactic txs for cluster headaches?

A
  1. calcium channel blockers
  2. lithium
  3. anti-epileptics
33
Q

Dx?

very brief pain in the trigeminal nerve dist. lasting less than 1 sec up to 2 mins

  • pain is one of the following:
    • intense
    • sharp
    • superficial
    • stabbing
A

trigeminal neuralgia

34
Q

What is diagnostic for trigeminal neuralgia?

A
  • very brief pain in the trigeminal nerve dist. lasting less than 1 sec up to 2 mins
  • pain is one of the following:
    • intense
    • sharp
    • superficial
    • stabbing
35
Q

What is the diagnostic criteria of cluster headache?

A
  • at least 5 episodes of severe, unilateral, periorbital and/or temporal pain that lasts 15-180 mins
  • recurs at least e/o day up to 8x/day
  • one of the following ipsillaterally:
    • conjunctival injection
    • lacrimation
    • nasal congestion
    • rhinorrhea
    • eyelid edema
    • ptosis
    • miosis
    • facial swelling
    • ear fullness
    • restlessness/agitation
36
Q

What is the diagnostic criteria for migraine?

A
  • at least 5 recurring HAs that last 4-72 hours characterized by at least 2:
    • unilateral
    • pulsating
    • moderate to severe intensity
    • pain increases w/ phys activity
      • AND at least 1 of these:
        • nausea/vomiting
        • photophobia/phonophobia
37
Q

What often precedes subarachnoid hemorrhage (SAH)?

A

a sentinel HA (a lesser intensity HA due to a small hemorrhage that heralds a subsequent massive hemorrhage)

38
Q

What are the diagnostic criteria of tension headache?

A
  • at least 10 episodes of HA that last 30 mins to 7 days
  • at least 2 of the following:
    • pressing or tightening sensation
    • mild to moderate severity
    • bilateral
    • not aggravated by phys activity
    • NO nausea/vomiting
    • EITHER photophobia OR phonophobia
39
Q

Before or simultaneously with the onset of aura symptoms, regional cerebral blood flow is _____ in the cortex corresponding to the clinically affected area or wider.

A

decreased

40
Q

What triggers trigeminal neuralgia?

A

sensory stim of a particular area w/in the trigeminal sensory innervation

41
Q

What are the 3 txs for trigeminal neuralgia?

A
  1. anti-epileptics (gabapentin, pregablin, carbamazepine, topiramate)
  2. baclofen
  3. surgical decompression of the nerve
42
Q

This is an alteration in mood, alertness, and/or appetite up to 24 hours before the HA.

A

the premonitory phase of a migraine

43
Q

What is the pathophys behind trigeminal neuralgia?

A
  • vascular compression of the trigeminal nerve
  • demyelination of the trigeminal nerve w/in the pons
44
Q

What innervates the structures in the cranium that carry pain fibers?

A
  • the trigeminal nerve
  • roots C2-C4
45
Q

Dx?

  • at least 5 recurring HAs that last 4-72 hours characterized by at least 2:
    • unilateral
    • pulsating
    • moderate to severe intensity
    • pain increases w/ phys activity
      • AND at least 1/2 of these:
        • nausea/vomiting
        • photophobia/phonophobia
A

migraines

46
Q

What is a sentinel HA?

A

a lesser intensity HA due to a small hemorrhage that heralds a subsequent massive hemorrhage

47
Q

What is the most common cause of a sudden, intense, incapacitating, “thunderclap, worst headache of my life” headache?

A

subarachnoid hemorrhage (SAH)

48
Q

Where does HA from uncontrolled HTN usually occur?

A

at the vertex

aNeuro Exam 2- Lindsey's (23 decks)

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