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Neurology > Headache > Flashcards

Headache Flashcards

1
Q

When should we worry about headache?

A 
SNOOPS
Systemic Symptoms
Neuro signs
Onset (sudden)
Old (50+ w/ new headaches)
Prior History
Secondary Illness
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2
Q

What are the charicteristics of Traction Headaches?

A

Steady, non-throbbing, deep, dull ache; can awaken from sleep
Progressive freq and dur
Cause: Neoplasm, abcess, Chronic SDH

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3
Q

WHat are the traits of Subarachnoid Hemorrhage?

A

Peaks within one minute (very intense) (thunderclap)
Intracerebral bleeding, embolic stroke, trauma, RCVS
CSF needed even if CT neg

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4
Q

What are the complications of Reversible Cerebral Vasocontstriction Synd?

A

Local Cortical SAH
Stroke
Posterior Reversible Encephalopathy Synd

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5
Q

What are the traits of a Meningitis Headache?

A 
Similar to migraine
-severe and global
-throbing
-N/V, photophobia
CSF culture needed
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6
Q

What causes a Low pressure headache?

A

Post LP
CSF Rhinorrhea
Inappropriate shunt
1^ IC Hypotension

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7
Q

What causes a High pressure headache? Features?

A

Idiopathic IC HTN
Risk of permanent visual loss
Papilledema

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8
Q

What are the features of Cranial Arteritis?

A 
Tender artery
ESR >60mm/hr
Throbbing/boring/burning
JAW CLAUDICATION
Steroid Tx to prevent blindness
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9
Q

What are the features of Trigeminal Neuralgia?

A 
Trigeminal distribution
-No autonomic symptoms
-Bilateral? MS
-Brainstem Tumors 
-Idiopathic or microvascular-compressive
Tx: AED(lamotrigine)
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10
Q

What is CADASIL?

A

Cerebral AD Arteriopathy w/ subcortical infarcts and leukencephalopathy

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11
Q

What are features of Episodic Tension type headache?

A

most common 1^ headache
Non-pulsitile
Non-disabling
Relief with OTC analgesics

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12
Q

What combo of symptoms qualify a Migraine?

A

2 of: Unilateral, throbbing, worse w/ movement, mod or severe
1 of: N/V, Photophobia, Phonophobia

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13
Q

What is the primary cause of migraine headache ?

A

Hyperexcitable: Visual Cortex
Dysmodulated: Dorsal Pons

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14
Q

What is reqired in order to have a sinus headache?

A

Sinusitis
Purulent nasal drainage
Pathologic sinus findings

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15
Q

What is the acute Tx of Migraine HEadache?

A

Non-Presc: NSAIDS, caffeine, etc
Presc: Triptans, Narc combos, Dihydroergotamine, Dopamine Agonists w/ combo of others
Steroids

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16
Q

WHat is the MOA of Triptans?

A

Vasodilation of neural BVs Serotonin Receptor Agonists

17
Q

What drugs are used for migraine prevention?

A 
Topiramate
Divalproex Na
Timolol
Propanolol
Chronic? Botox
18
Q

What are the principles of Sucessful Migraine Prevention?

A

Allow adequate time
Consider comorbids
Ensure no contraindications
Appropriate expectations

19
Q

What are the traits of Cluster headachess?

A

Piercing unilateral stabbing pain; 1-10 per day; most male
**Ipsilateral lacrimation and nasal congestion
Pt active during attack

20
Q

What are useful abortives for Cluster Headaches?

A

Sumatriptan

10-15 L/min O2

21
Q

What meds are used for Prevention of cluster headaches?

A 
Verapamil
Divalproex Na
Topirimate
Lithium
Oral steroids as bridge therapy
22
Q

What are the traits and Tx of Paroxysmal Hemicrania?

A

Up to 40 attacks per day

Excellent response to Indomethacin

23
Q

What are the traits of Hemicrania Continua?

A

SIDE LOCKED
No pain free periods-pain can wax and wane
AL one Autonomic symptom ips to pain
Complete response to Indomethacin is diagnostic

24
Q

What are other Indomethacin Responsive headaches?

A

Cough, Coital, Idiopathic stabbing, exercise

MUST exclude posterior fossa lesion (chiari malf)

25
Q

What is the cause of Medication induced headache?

A

Overuse of acute medications => chronic daily headache

26
Q

What constitutes a Combo Medication-Overuse Headache?

A

Intake of Combination meds on >10 days/month for >3 months

27
Q

What constitutes an Analgesic Overuse Headache?

A

intake of simple analgesics on >15 days/month for >3 months

28
Q

What is the Tx of Med Overuse HEadache?

A

Disc PRN use for mild headache in WOP
Provide meds for mod/severe intensity headaches
Restrict to 10days/mon
NO REFILLS for PRN MEDS during WOP

Neurology (9 decks)

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