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Neuro_week3 > Headache > Flashcards

Headache Flashcards

1
Q

Difference btwn primary vs secondary headache syndrome

A

Primary = > 90% of HA
No underlying pathology
usu recurrent

Secondary = less than 10% of cases
underlying intracranial or systemic pathology

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2
Q

Tension HA
Frequency

Characteristics

A

10 episodes lasting 30min-7days

2 of the following:

1) pressing/tightening sensation
2) mild-mod severity
3) b/l
4) physical activity fine

No n/v, but +/- photo OR phonophobia

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3
Q

Tension HA
Treatment to stop

Treatment to prevent

A

Aspirin, acetaminophen, NSAIDS

TCA (amitryptiline), SSRI, psychotherapy, physical therapy

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4
Q

Migraine HA
Potential causes?

migraine with aura resembles?

A

perivascular release of vasoactive substances causing sensitization of trigeminal affernets, vasodilation, migraine pain

resembles cortical neuronal spreading depression (CSD) –> CBF decreases to affected area and spreads out

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5
Q

Migraine HA

Triggers

A

1) lack of sleep
2) ETOH
3) caffeine withdrawal
4) perimenstruation
5) “relief of stress”
6) foods

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6
Q

Migraine HA

more in males or female

A

more females

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7
Q

Migraine HA

Diagnostic criteria

A

at least 5 episodes that last 4-72 hrs

2 of the following:

1) unilateral
2) pulsation
3) mod - severe
4) incr with physical activity

1 of the following:

1) n/v/
2) photophobia
3) phonophobia

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8
Q

Migraine HA

Phases

A

1) premonitory= change mood, alert, appetite 24 hrs before
2) aura = neuro sx before HA
3) HA + symptoms
4) resolution = post HA exhaustion and lethargy

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9
Q

Migraine HA

Describe aura

A

reversible symptoms of one of
visual, language, sensory, motor, brainstem, retinal

2 of
homonymous visual or unilateral sensory change, gradual over 5min, sx btwn 5-60 min then HA

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10
Q

Migraine HA

Treatment to stop

A

ASA, acetaminophen, NSAID

combo = ibuprofen + caffeine + ASA
or Acetaminophen + caffeine + ASA

5HT agonists
selective = triptans (5HT 1B/1D agonists for vasoconstrict)

nonselective = ergotamine

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11
Q

Migraine HA

Treatment to prevent

A

1) beta blocker
2) CCB
3) TCA
4) antiepileptics
5) botox for chronic migraine

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12
Q

Migraine HA

Alternative therapy

A

1) sleep
2) biofeedback
3) acupuncture
4) OTC/herbal, vit B2, Mg2+

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13
Q

Cluster HA = trigeminal autonomic cephalgias

1) frequency
2) men or woemn
3) triggers

A

1) rare
2) more in men
3) triggers = EtOh and vasodilators

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14
Q

Cluster HA = trigeminal autonomic cephalgias

diagnosis

A

5 episodes of severe, unilateral, periorbital and/or temporal pain for 15-180 min

recur every other day 8x/day

one of the following autonomic sx

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15
Q

Cluster HA = trigeminal autonomic cephalgias

treatment to stop

A

1) oxygen
2) 5HT agonists (triptan, ergots)

3) lidocaine
4) corticosteroids
5) nerve blocks

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16
Q

Cluster HA = trigeminal autonomic cephalgias

treatment to prevent

A

1) CCB
2) lithium
3) antiepileptics

17
Q

Secondary HA

head trauma = concussion
demographics to get post-mild TBI HA

symptoms

treatment

A

young pts and men less likely to get post-mild TBI HA

pain within 1 week resolve by 3 months
dizziness, poor concentration, irritable, insomnia

treatment = pain meds

18
Q

Secondary HA

infection = meningitis = bacteiral, fungal viral
symptoms

diagnosis

A

acute pain less than 2 days
HA, n, v, fever, stiff neck, altered consciousness
Kernig’s
brudzinski’s

dx = lumbar puncture

19
Q

Secondary HA

vascular disorders = SAH
usu from?
sx

A

usu from trauma or ruptured aneurysm, AVM

sudden worst HA of life, stiff neck, photophobia, n/v, obtunded

20
Q

Secondary HA

SAH diagnosis
treatment

A

diagnosis = immediate CT, LP = xanthochromia ~ 12 hrs), CTA

treatment = depends on cause = surgery

21
Q

Secondary HA

vascular disorders = Giant cell arteritis
due to?
risk factor

A

inflamm of elastic lamina

risk factor = age

22
Q

Secondary HA

giant cell arteritis
symptoms

A

jaw claudication
temporal artery tenderness
vision loss (optic nerve infarct)
joint pain

fever, malaise, weight loss

23
Q

Secondary HA

giant cell arteritis
diagnosis
treatment

A

dx = high ESR, CRP, temporal artery biopsy

tx = steroids

24
Q

Secondary HA

Incr ICP
ddx

A

1) tumor
2) AVM
3) infection
4) SAH, intracerebral hemorrhage, dural venous thrombosis
5) minocycline
6) trauma
7) pseudotumor cerebri or idiopathic intracranial HTN

25
Q

Secondary HA
incr ICP
symptoms?

A

1) exertional HA
2) retrobulbar pain
3) n/v
4) pulsatile intracranila noises
5) transient visual obscure
6) diplopia

1) papilledema
2) vision loss
3) HA worse when wake up

26
Q

Secondary HA

incr ICP
dx
treatment

A

dx = measure ICP, CT/MRI / NO LUMBAR PUNCTURE

treatment = depends

27
Q

pseudotumor cerebri

appearance on LP and imaging
neuro exam
seen more in…

A

LP and imaging = normal

normal neuro except papilledema and CN 6 palsy

obese, middle age, women

28
Q

how to diagnose HA?

A

1) detailed history
2) exclude secondary HA
SSNOOP

29
Q

pneumonic SSNOOP

A

systemic symptoms (fever, weight loss)
secondary risk factors (HIV, cancer, auto)
Neuro (confusion, depress conscious, focal)
Onset (sudden, abrupt, first or worst)
Older (new or progressive esp older than 50)
previous HA (frist, changed freq or clinical features)

30
Q

cranial neuralgia = trigeminal neuralgia

1) primary or secondary
2) causes

A

1) both primary + secondary
2) causes = idiopathic (primary), vascular compression of vessel on trigeminal nerve (secondary), demyelination MS (secondary)

31
Q

cranial neuralgia = trigeminal neuralgia

diagnosis
triggers

A

1) very brief (up to 2 min) in trigeminal
2) intense, sharp, superficial, or stabbing
3) triggered by stim of trigem (chew or brush teeth)

32
Q

cranial neuralgia = trigeminal neuralgia

treatment

A

antiepileptics
baclofen
surgical decompression

33
Q

Episodic headache for 12 years
Duration of episodes: 5-12 days
Frequency of episodes: 1-2/month, worsening
Features: neck stiffness and pain, radiating whole head (“exploding”)
P/P, severe N and V → dehydration, weight loss
swollen eyelids, balance difficulties
Head CT: normal. Nerve stimulator C1-C2
No reponse to numerous therapies

A

Diagnosis: Chronic Migraine

Significant improvement with Botox injections

Neuro_week3 (23 decks)

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