Headache

Question 1

Cranial structures not sensitive to pain (4)

Answer 1

• ventricles
• choroid
• parenchyma (-midbrain)
• small veins

Question 2

Part of midbrain sensitive to pain

Answer 2

dorsal raphe nucleus

Question 3

Three main headache groups

Answer 3

• primary
• secondary
• cranial neuralgia

Question 4

Migraine pathophysiology: l

Answer 4

• begin in brainstem
• trigeminal system activation
• activation of chemoreceptors and autonomic nervous system

Question 5

How common is aura in migraine?

Answer 5

-60-70% of migraines

Question 6

Describe complicated migraine

Answer 6

-long dramatic aura, may mimic stroke

Question 7

Basilar migraine:

• location
• assc symptoms

Answer 7

• occipital throbbing pain

- vertigo, dysarthria, ataxia

Question 8

Contrast bickerstaffs migraine and simple basilar migraine

Answer 8

-bickerstaffs begins with total blindness

Question 9

List four abortive therapies for migraines

Answer 9

• NSAIDs
• Triptans
• DOPA antagonists
• Combos

Question 10

Which triptan is short acting? long acting?

Answer 10

• sumatriptan: short
• zolmi: intermediate
• frova: long

Question 11

List the two dopa antagonists for migraines

Answer 11

• metoclopramide (reglan)

- prochlorperazine (Compazine)

Question 12

When is migraine prophylaxis needed?

Answer 12

• migraines 3+ times per month

- functional impairment

Question 13

List five drug classes used for migraine prophylaxis

Answer 13

• BBers
• CCBs
• TCAs
• Anticonvulsants
• Serotonergic Drugs

Question 14

List the four anticonvulsant drugs for migraine prophylaxis:

Answer 14

• keppra: leviteracetam
• Depakote: valproic acid
• Topamax: topiramate
• Neurontin: gabapentin

Question 15

Describe cluster headache

Answer 15

severe unilateral stabbing periorbital/ temporal pain

Question 16

Pathway involved in cluster headache pathogenesis:

Answer 16

-trigeminal-hypothalamic pathway

Question 17

How is O2 administered for cluster H/A?

Answer 17

-12L/min for 15 mins

Question 18

Prophylactis for cluster HA

Answer 18

• steroids

- CCBs

Question 19

1 HA disorder

Answer 19

tension headache

Question 20

Tension H/A never includes:

Answer 20

-N/V

Question 21

Abortive therapy tension HA

Answer 21

• Acetaminophen

- NSAIDs

Question 22

Prophylaxis tension HA

Answer 22

• TCA

- gabapentin

Question 23

Drugs assc with idiopathic intracranial hypertension

Answer 23

• TCN
• OCPs
• vitamin A

Question 24

How should LP be done in IIH?

Answer 24

-lateral decubitus position

Question 25

Two treatments for IIH (drug)

Answer 25

• acetazolamide

- topiramate

Question 26

Warning signs for headache:

-three types

Answer 26

• worst ever
• first severe
• subacute worsening

Question 27

Warning signs for headache:

-five assc symptoms

Answer 27

• abnormal exam
• fever
• vomiting
• worsening with bending/lifting/coughing
• disturbs sleep

Question 28

Warning signs for headache:

age

Answer 28

-55+