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Neuro Clerkship > Headache > Flashcards

Headache Flashcards

1
Q

Migraine without aura:

  • Describe the presentation
  • How long does the HA last?
A
  • Unilateral HA + photo/phonophobia, N/V, etc.

- Between 30 min- 4 hrs

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2
Q

Migraine with aura:

  • Describe the presentation
  • When does the aura present
  • What might the aura be (3)
  • How commonly does aura occur with migraine?
A
  • Same as migraine w/out aura
  • Aura presents up to 30 min before HA onset or WITHIN 1 hr of HA onset
  • May be visual, focal parasthsia, or motor disturbance
  • Occur in 60-70% of migraines
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3
Q

Define complex migraine–with what neurologic phenomenon might it be confused?

A

Presents like more dramatic migraine with aura; may be confused with stroke

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4
Q

Basilar Migraine: describe clinical presentation

A

Posterior circulation sx (vertigo, ataxia, diplopia, dysarthria)–> HA 20-30 min later (occipital throbbing pain)

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5
Q

Bickerstaff’s migraine: describe clinical presentation (2)

A
  • most severe basilar migraine

- total blindness–> vertigo/ ataxia/ dysarthria/ tinnitus

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6
Q

3 forms of abortive therapy for migraines:

A
  • NSAIDS
  • 5HT1 agonists (Triptans, ergots)
  • DA agonists
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7
Q

Sumatriptan: onset and duration

A

short onset and duration

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8
Q

Zolmitriptan: onset and duration

A

intermediate onset and duration

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9
Q

Frovatriptan: onset an duration

A

long onset and duration

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10
Q

List two DA agonists used to treat migraines:

A
  • Metaclopromide (Reglan)

- Prochlorperazine (Compazine)

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11
Q

List 5 general drugs that are used for migraine px:

A
  • Beta blockers (propranolol)
  • Ca++ channel blockers (verapamil)
  • TCAs (Amitriptyline, Nortriptaline)
  • Anticonvulsants (Gabapentin, Topirimate, valproate)
  • Seritonergics (Cyproheptadine)
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12
Q

Cluster HA:

  • Type of pain
  • Duration, frequency of HA
  • Characteristic timing?
  • Associated sx
A
  • Sharp, stabbing, periorbital
  • 1-3 15 min-3hr long HAs occurring in clusters of 3-6 weeks
  • SAME TIME DAILY (circadian rhythm)
  • Red eye/ lacrimation, miosis, ptosis, rhinorrhea/ nasal congestion, perspiration
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13
Q

Best acute treatment for cluster HA?

What abortive treatment can be used for both cluster HA and migraine?

A
  • High concentration O2

- Triptans (good in 75% its)

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14
Q

What are two prophylactic treatments for cluster headaches?

Which is good for both cluster and migraine?

A
  • High dose steroids (often on combo with Ca++ blocker) –> very effective decrease in frequency
  • Ca++ channel blockers work for both migraines and clusters
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15
Q

Tension HA are never associated with…

A

N/V

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16
Q

What are 2 prophylactic treatments for tension HA?

A
  • TCAs

- Antiepileptics (gabapetin)

17
Q

Which drugs are associated with idiopathic intracranial HTN (3)

A
  • TCNs
  • OCPs
  • Retanoic acid/ hypervitamiosis A
18
Q

Describe the HA of idiopathic intracranial HTN?

  • Does it come and go?
  • What makes it worse? (3)
  • List two severe sequelae?
A
  • Continuous daily HA
  • Worse with coughing, sneezing, moving to supine position
  • Vision loss, diplopia, pulsatile tinnitus
19
Q

Workup for IIH? (2 steps)

A
  • MRI brin with MRV: rule out mass

- LP in lateral decubitus position w/ attention to opening pressure–both diagnostic and therapeutic

20
Q

List the treatments for IIH:
2 Behavioral
2 drugs
3 procedural

A
  • Weight loss + remove offending drugs
  • Acetazolamide or Topiramate to decrease CSF production
  • Recurrent LPs, optic nerve fenestration, ventriculoperitoneal shunt
21
Q

Giant Cell (Temporal) Arteritis:

  • Population
  • Describe pain
  • 4 associated sx
A
  • 50+ yoa
  • Unilateral throbbing pain w tender temporal artery
  • jaw claudication, joint pain, visual disturbance, transient monocular vision loss
22
Q

Gold standard for temporal arteritis dx + two others:

A
  • Temporal artery biopsy

- ESR, CRP

23
Q

Treatment for temporal arteritis:

A

High dose steroids –> relief in 3 days

Low dose steroids for years (chronic disease)

24
Q

Steps to workup acute onset severe HA:

A
  • CT (r/o hemorrhage, large mass, hydrocephalus)
  • MRI (more subtle pathology) REQUIRED for abnormal near exam
  • LP w/ febrile illness, immunocompromised, hemorrhage

Neuro Clerkship (13 decks)

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