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MHD > Headache > Flashcards

Headache Flashcards

1
Q

Define Primary Headache

A

Headache with no underlying disease process

Generally benign and will not be fatal or cause long term neuro deficit

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2
Q

Define Secondary Headache

A

Headache as a secondary manifestation for another disease process

Much more concern about imminent death or neuro deficits

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3
Q

What are some “red flags” for Aneurysmal SAH or cerebellar hematoma?

A

Split second, unexpected worst headache of life

LOC

Vertigo

Vomiting

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4
Q

What are some “red flags” for meningitis?

A

Headache, fever, skin rash

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5
Q

What are some “red flags” for cryptomeningitis or toxoplasmosis?

A

Immunocompromised

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6
Q

What are some “red flags” for subdural or intradural hematomas?

A

Coagulopathy or the patient is on anticoagulation therapy

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7
Q

What is a migraine?

A

Genetic condition in which a person has a predisposition to episodic headaches, GI disturbance (nausea) or neuro dysfunction

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8
Q

How often do migraines typically occur? Where? What kinds of patients tend to develop migraines?

A

Typically once or twice a month

Unilateral

Often begin in late childhood or early adulthood (menarche to menopause)

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9
Q

What are the 4 typical phases of a migraine?

A
  1. Prodrome
  2. Aura
  3. Pain
  4. Postdrome
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10
Q

Describe the Prodrome phase of a migraine

A

Occurs days-hours before the migraine begins

May develop depression, irritability, drowsiness, fatigue, hunger/thirst, rhinorrhea/lacrimation, yawning

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11
Q

Describe the Aura phase of a migraine

A

Often visual aura (“fortification phenomenon”)

Usually develops over 5-20 min and lasts over an hour

Numbness/tingling of face or arm
Dizziness
Diplopia

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12
Q

How would you differentiate between the aura of a migraine versus the aura of Retinal Detachment?

A

Retinal detachment– flashing lights that come and go after a few seconds

Migraine Aura–stay for an extended period of time before the migraine

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13
Q

Describe the Pain phase of a migraine

A

Pain may be in head, abdomen, or chest

Onset is gradual, over min-hours

May last for hours or days

Maybe associated with photophobia, phonophobia, nausea

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14
Q

People who get migraines are often genetically setup for them. What is the mutation and how does it cause the migraines?

A

Gain of function mutation in an NMDA receptor, which is excitatory

NMDA receptor activation leads to burst of focal cerebral activity, which leads to local hyperemia and increased blood flow

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15
Q

Describe the feedback loop that allows migraines to persist

A

Trigeminal nerves become activated and they release neuropeptides (CGRP, substance P, neurokinin A)

CN V sends a message to dilate blood vessels in brain

Creates a constant feedback loop

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16
Q

Describe the Postdrome phase of a migraine

A

Present for several hours after the pain ends

Mood changes (euphoria, fatigue)

Impaired concentration

Scalp and muscle tenderness

17
Q

What is the first line treatment for mild migraines? What if that doesn’t work?

A

First line treatment is NSAIDs

Move on to stronger drugs if that fails (triptans)

18
Q

Triptans

MOA

A

Agonists of the 5-HT 1B/D receptors

Cause vasoconstriction of blood vessels

19
Q

Triptans

Contraindications

A

Do NOT use in pregnant women or in patients who are at risk for ischemic heart disease

Also avoid with renal disease or HTN

Avoid if on MAO inhibitor

20
Q

Triptans

Adverse Effects

A

Warm/hot sensations

Chest tightness

Tingling

Pressure sensations

Potential risk for serotonin syndrome

21
Q

What is Serotonin Syndrome?

A

Excess activation of 5HT 1A and 5HT2 receptors

Leg rigidity
Lacrimation
Excess bowel sounds
Myoclonus
Hyperreflexia
Seizures
22
Q

Ergotamine

Indications

A

Less specific than triptans

Potent arterial vasoconstrictors

23
Q

DHE = Dihydroergotamine

Indications

A

Significant arterial and venous vasodilator

More side effects associated than ergotamine

24
Q

When are ergots (DHE, ergotamine) contraindicated?

A

Ischemic heart disease

Collagen vascular disease

cardiac valve disease

HTN

Hemiplegic/basilar migraine

Pregnant women

25
Q

When would Botox be indicated for migraines?

A

Only for chronic migraine headaches

Only after patient has failed many other meds and has frequent headaches

26
Q

Cluster Headaches

Who is most likely to get one?

A

Males, typically in their 40s, who smoke and drink alcohol

27
Q

Cluster Headaches

How long do the headaches tend to last? Where are they?

A

Usually unilateral headaches

Clusters last 6-12 weeks and occur every 1-2 years, but the headaches themselves occur 1-4x per day and last 20-30 min each

28
Q

Cluster Headaches

Effective therapies?

A

Inhaled O2

Injectable sumatriptan

Nasal sprays

Prednisone is a last ditch option

29
Q

What is the most common form of headache in adults?

A

Tension-type headache

30
Q

Tension-type headache

Clinical Features

A

Bilateral pain, lasting over 30min

Band-like, pressing or tightening pain

No nausea and not aggravated by activity

Could have photophobia or phonophobia, but NOT BOTH

31
Q

Tension-Type Headaches

Treatment

A

Go to sleep,
Eat better,
Don’t smoke

32
Q

Trigeminal Neuralgia

Clinical Features

A

Shooting pain radiating down jaw is classic distribution

33
Q

Trigeminal Neuralgia

Causes

A

Likely due to tortuous artery compressing the trigeminal nerve in older people

In young people, often caused by MS

34
Q

Trigeminal Neuralgia

Treatment

A

Carbamazepine is first line therapy for pain control

35
Q

Pseudotumor Cerebri

Who gets it?

A

Often overweight females

36
Q

Pseudotumor Cerebri

What is it?

A

Neurologic emergency

Weight increase –> inc in intraabdominal pressure –> impairs venous outflow and increases intracranial pressure

May cause blindness

37
Q

Primary Exertional Headache

Clinical Features and treatment

A

Pulsating HA occuring only during or after physical activity

Treat with Indomethacin before they exercise

MHD (57 decks)

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