Headache Flashcards
throbbing, pounding, pulsatile headache
vascular headache
gender w/ migraines more often and predisposing factor
women - hormonal changes during menstrual cycle
classical migraine
migraine w/ aura
common migraine
migraine w/out aura
wave of depol over focal areas of cerebral cortex
aura of a migraine
manifestation of visual aura
flashing, flickering, scintillating lines or dots that spreads thru visual field
patch of blindness
scotoma
fortification phenomenon
visual aura w/ flashing lights in zig zag pattern
cause of flashing lights and scotoma
depol of occipital visual cortex
has dramatic frightening sxs w/ HA and mimic acute stroke
complicated migraine
sxs of complicated migraine
may be hemiplegia, opthalmoplegia, or CN3 palsy
unilateral periorbital pain +/- Horner’s
cluster HA (may have nasal discharge or congestion)
early cause of migraine
spreading wave of cortical depol
area affected when N/V and photophobia occur
trigeminal afferent’s that transmit impulses to brainstem and hypothalamus
red flags of HA
progressively worsen, focal neuro deficits, or is accompanied by seizures or cognitive/behavioral changes
preferable brain scan for HA (if needed)
MRI
triptans are used for
migraine abortion
2 meds for migraine abortion
triptans and dihydroergotamine
effect of OCPs on migraine
help prevent it
inc risk of ___ in women w/ migraine w/ aura, especially if they are ____
stroke
smokers > 35 y/o
prophylactic drugs for migraines
beta blockers (propanolol) Ca channel blockers (verapamil) TCAs (amitryptiline) anticonvulsants (valproate, gabapentin, and topiramate)
MOA for migraine prophylaxis and abortion
effect 5HT receptors
Patients with frequent ____ headaches often have
several chronic psychosocial stresses
tension
amitriptyline can be used for
migraines, tension HA
stopping butalbital (barbiturate) after using it for a while can give
rebound HA
HA after LP
traction headache
traction HA are worse when? better when?
are positional
worse w/ sitting/standing
better w/ laying down
cause of traction HA
CSF leak
traction HA tx
epidural blood patch (inject person’s own blood into epidural space)
throbbing HA w/ N/V in obese people w/ papilledema
IIH (pseudotumor cerebri)
removal of CSF is used to treat
IIH (pseudotumor cerebri)
long term tx for IIH (pseudotumor cerebri)
acetazolamide, surgical shunt, weight loss
HA in elderly w/ sore jaw muscles, stiff shoulder/hip muscles, low grade fever or high ESR
temporal arteritis
confirmatory test for temporal arteritis
biopsy
tx for temporal arteritis
corticosteroids - give immediately to prevent blindness from involvement of opthalmic a.
sudden, brief, repeated, lightning jabs of pain provoked by talking/chewing
trigeminal neuralgia
HA with meningeal signs and fever
menigitis
HA with meningeal signs but no fever
SAH
inc intracranial pressure gives
N/V, intermittent dimming of vision
reason to do brain imaging before LP in someone w/ papilledema
avoid brain stem herniation
reason there’s no herniation w/ LP for pseudotumor cerebri
Intracranial pressure is diffusely inc, compared to the asymmetrical or uneven pressure gradient from an intracranial mass
scintillating scotoma
visual aura
