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Neurology > Headache > Flashcards

Headache Flashcards

1
Q

2 classes

1ary vs 2ary

A

1ary EXCUSION Dx = migraine, tension, cluster HA

2nary = bleeding, NOT STROKE, hydrocephalus, meds, CO poisoning

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2
Q

Path

A

1ary - don’t know

Combo of these:

  • Genetics
  • Triggers
  • CNS pain pathways
  • Med overuse
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3
Q

History Most important question

A

Have you ever had like this before?

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4
Q

1ary likely if:

A
  • Typical HA (character)
  • Ran out of meds
  • Slow onset (over 10-15 minutes)
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5
Q

Concerning Factors in assessment

A
  • NOT Typical HA
  • Worst of Life
  • Onset quick
  • progressively worsening daily HA = growing tumor
  • Toxic appearing
  • altered neuro (Focal) - consciousness change
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6
Q

Time course of HA

Migraine
Tension
Cluster
Tumor

A

Migraine = regular periodic

Tension = constant (a few breaks)

Cluster= 6-8 SEVERE together in 3 week period, then nothing for months, then cluster

Tumor - growing

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7
Q

Tension HA

A

Spread to neck muscles

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8
Q
  • 10 previous
  • 30 mins - 7 days (long)
  • 2 of follwing
  • NO N/V
  • Photophobia OR phonophobia

Dx

A

Tension

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9
Q

Tension HA

Risk factors

A
  • women slightly more
  • lower SES
  • Cause: TMJ, Stress, Analgesic overuse, Depression
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10
Q

Tension HA

Tx

A
  • NSAIDs/Acetamenophen
  • combo products w/ caffeine
  • Trigger ID
  • Heat, warm, bath, muscle relaxants
  • PT
  • severe = anti-emetics, barbituates, opiates
  • Treat depression (also CSD - serotonin action)
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11
Q

Tension headache

Chronic Daily Headache

Cause

A
  • 2ndary to med overuse
  • depression
  • PTSD
  • Hx sexual abuse
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12
Q

Tension headache

Chronic Daily Headache

Tx

A
  • underlying issue
  • wean off meds - support with ADD
  • psycotherapy, cognitive therapy

*healthy lifestyle

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13
Q
  • unilateral, throbbing, behind eye
  • w/. Or w/o aura
    • visual/taste + smell/depression out of nowhere
  • N/V
  • photophobia, phonophobia
  • want to NOT MOVE, NO SOUND/LIGHT

S/s

A

Migraine

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14
Q

Migraine

Who?

A

*more women
(“Menstrual migraines”)
*heredity
*impairs life function

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15
Q

Aura types

A

Scotoma

Fortification spectra

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16
Q

Classic Migraine

A
  • aura
  • focal neuro deficits
  • N/V
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17
Q

Common Migraine

A

NO aura

No focal neuro definitions

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18
Q

Migraine

Tx

A

*Triptans (BEST)
*ergots
Right at beginning
WATCH w/ Vascular problems = Rx vasoconstricts

  • anti-emetics
  • Steroids
  • opiates = rebound HA possible!!
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19
Q

Acute Migraine

Tx

A

1st line = Triptans
*5HT1 ags = vasoconstrict

  • ASA, tylenol, NSAIDS
  • usually tried something b/f
  • steriods, opiates
20
Q

Migraine Triggers

A 
Caffeine
Foods
Strong scents
Change in weather
SLEEP HYGIENE
Mood
stress 
Meds
Period
21
Q

Cluster HA

Tx

A
  • High flow O2
  • abortive Tx (triptan, ergotamines)
  • opiates
  • steroid = break cluster cycle
22
Q

Cluster HA

Prevention

A

1st line = CCB (verapamil)

  • lithium (but S.E.)
  • NO BBlocker = not like migraine
23
Q

Subarachnoid Hemorrhage

Ateriorvenous Malformation (AVM)

A

Venous + artery hooked together w/o capillary = too much pressure to veins (stretch, rupture)

24
Q

Aneruysm

cause?

A

Congenital, HTN

25
Q

Sub-arachnoid Hemorrhage

if Normal CT…

A

Can diffuse out over CSF w/ time

*LP!

Patient waits too long b/f coming in

26
Q

If suspect Sub-arach hemorrhage or Meningitis… CT +…

A

LP!

  • SAH = xanthochromia
  • Meningitis = up protein, down glucose
27
Q

Aneurysm treatment

Clipping vs. coiling

A

Coiling = don’t need to dig thru brain tissue to get at circle of willis
But must have neck (not bell curve)

28
Q

2ndary HA common causes

A 
Dehydration
CO
Sinusitis
Otitis
Acute Glaucoma
Influenza
Toxins
Concussion
29
Q
  • bilateral
  • non-throbbing
  • slow onset
  • NO N/V
  • NO Photo/phonophobia
  • NO focal neuro signs
  • wants rest
  • “stress”/”bad nerves”

S/s

A

Tension HA

30
Q

Tension HA

Prevention

A
  • stress management

* healthy lifestyle

31
Q

Chronic Daily Headache

Possible other path/causes

A
  • Tumor
  • CSF leak
  • COPD
  • Thyroid conditions
  • HTN
  • Sleep apnea
32
Q

Migraine

Initiation of Prophylaxis guidlines

A

6+ per month - DEFINITELY

2+ w/ severe impairment - CONSIDER

(Others)

33
Q

Migraine Prophylaxis

Rx

A

Level A =

  • BBlocker (Propranolol, Metoprolol)
  • Anti-convulsants (Divalproex sodium, Valproate, Topiramate)

Level B =

  • ADD (amitriptyline, Venlafaxine)
  • BBlocker
34
Q
  • Intermittent HA
  • Men
  • Unilateral
  • Unilateral rhinorrhea/lacrimation
  • maybe unilateral ptosis/myosis

s/s?

A

Cluster HA

*rare

35
Q

Cluster HA

Path

A
  • unknown
  • hypothalamic
  • trigeminal pain pathways
36
Q
  • quick onset
  • eye/temple pain
  • unilateral w/ lacrimation/rhinorrhea
  • no other focal signs
  • restless, pacing patient

S/s?

A

Cluster HA

37
Q

Cluster HA looks like what else?

A

Sub-Arachnoid Hemorrhage

RULE OUT

38
Q
  • “worst HA of life”
  • N/V
  • nuchal rigidity
  • Photophobia
  • “Sentinal bleed” = Hx of recent severe headache that resolved

Present?

A

Sub-arachnoid hemorrhage

39
Q

Subarachnoid Hemorrhage

CT

A
  • Fresh blood

* NO common vascular distribution

40
Q

What if HA, then normal CT, but still S/s?

*Motor weakness, aphasia, dysartria, droop?

A

Early ischemic stroke

41
Q

What if HA, then normal CT, but still S/s?

*Acute onset HA, vomiting, photophobia, nuchal rigidity

A

SAH possible

42
Q

What if HA, then normal CT, but still S/s?

*Fever, infx exposure, nuchal rigidity?

A

Meningitis possible

43
Q

Sub-Arach Hemorrhage

Tx

A
  • Neurosurgeon evaluation
  • Large bleeds - surgical decompression
  • Avoid UP ICP = anti-emetics
  • Manage HTN (rebleed)
  • Nimodipine = DOWN vasospasm
44
Q

Can we do LP for epidural or subdural hemorrhage?

A

NO

*not in subarachnoid space

45
Q

AVM

Tx

A

Excision

Cauterization

46
Q

Aneurysm

Tx

A
  • small = watch + wait

* clip/coil

Neurology (20 decks)

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