Headache Flashcards
Migraine without aura:
- Describe the presentation
- How long does the HA last?
- Unilateral HA + photo/phonophobia, N/V, etc.
- Between 30 min- 4 hrs
Migraine with aura:
- Describe the presentation
- When does the aura present
- What might the aura be (3)
- How commonly does aura occur with migraine?
- 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
Define complex migraine–with what neurologic phenomenon might it be confused?
Presents like more dramatic migraine with aura; may be confused with stroke
Basilar Migraine: describe clinical presentation
Posterior circulation sx (vertigo, ataxia, diplopia, dysarthria)–> HA 20-30 min later (occipital throbbing pain)
Bickerstaff’s migraine: describe clinical presentation (2)
- most severe basilar migraine
- total blindness–> vertigo/ ataxia/ dysarthria/ tinnitus
3 forms of abortive therapy for migraines:
- NSAIDS
- 5HT1 agonists (Triptans, ergots)
- DA agonists
Sumatriptan: onset and duration
short onset and duration
Zolmitriptan: onset and duration
intermediate onset and duration
Frovatriptan: onset an duration
long onset and duration
List two DA agonists used to treat migraines:
- Metaclopromide (Reglan)
- Prochlorperazine (Compazine)
List 5 general drugs that are used for migraine px:
- Beta blockers (propranolol)
- Ca++ channel blockers (verapamil)
- TCAs (Amitriptyline, Nortriptaline)
- Anticonvulsants (Gabapentin, Topirimate, valproate)
- Seritonergics (Cyproheptadine)
Cluster HA:
- Type of pain
- Duration, frequency of HA
- Characteristic timing?
- Associated sx
- 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
Best acute treatment for cluster HA?
What abortive treatment can be used for both cluster HA and migraine?
- High concentration O2
- Triptans (good in 75% its)
What are two prophylactic treatments for cluster headaches?
Which is good for both cluster and migraine?
- High dose steroids (often on combo with Ca++ blocker) –> very effective decrease in frequency
- Ca++ channel blockers work for both migraines and clusters
Tension HA are never associated with…
N/V
What are 2 prophylactic treatments for tension HA?
- TCAs
- Antiepileptics (gabapetin)
Which drugs are associated with idiopathic intracranial HTN (3)
- TCNs
- OCPs
- Retanoic acid/ hypervitamiosis A
Describe the HA of idiopathic intracranial HTN?
- Does it come and go?
- What makes it worse? (3)
- List two severe sequelae?
- Continuous daily HA
- Worse with coughing, sneezing, moving to supine position
- Vision loss, diplopia, pulsatile tinnitus
Workup for IIH? (2 steps)
- MRI brin with MRV: rule out mass
- LP in lateral decubitus position w/ attention to opening pressure–both diagnostic and therapeutic
List the treatments for IIH:
2 Behavioral
2 drugs
3 procedural
- Weight loss + remove offending drugs
- Acetazolamide or Topiramate to decrease CSF production
- Recurrent LPs, optic nerve fenestration, ventriculoperitoneal shunt
Giant Cell (Temporal) Arteritis:
- Population
- Describe pain
- 4 associated sx
- 50+ yoa
- Unilateral throbbing pain w tender temporal artery
- jaw claudication, joint pain, visual disturbance, transient monocular vision loss
Gold standard for temporal arteritis dx + two others:
- Temporal artery biopsy
- ESR, CRP
Treatment for temporal arteritis:
High dose steroids –> relief in 3 days
Low dose steroids for years (chronic disease)
Steps to workup acute onset severe HA:
- CT (r/o hemorrhage, large mass, hydrocephalus)
- MRI (more subtle pathology) REQUIRED for abnormal near exam
- LP w/ febrile illness, immunocompromised, hemorrhage
