Headache

Question 1

what mechs can produce HA

Answer 1

stretching compressing and distorting intracranial blood vessels or CN

Question 2

migraines: with aura (classical) vs. without (common)

Answer 2

aura-wave of depolarization over focal areas o cerebral cortex; often visual; scintillating scotoma 2/2 depolarization of occipital visual cortex

Question 3

types of vascular headache

Answer 3

• migraines (classical vs common vs complicated)

- cluster HA

Question 4

complicated migraine

Answer 4

dramatic frightening s/s; mimic acute stroke syndrome

Question 5

cluster HA

Answer 5

more common in men

• unilat periorbital pain
• sometimes Horners

Question 6

mechanism of migraine

Answer 6

• spreading wave of cortical depolarization
• when it reaches trigeminal afferent nerves, trigeminovascular system is activated
• impulses sent to BS, hypothalamus=n/v/photphobia
• substance P can be released in neurogenic inflammation
• vasoD and INC permeability of blood vessels

Question 7

when are brain scans done/required

Answer 7

• when focal neurological findings are found on exam

- HA getting progressively worse, or accompanied by seizures, cognitive or behavioral changes

Question 8

what are two categories of HA tx?

Answer 8

a. abortive-lessen/stop HA thatre 1-2x/mo
- NSAIDS (ibuprofen, naproxen)
- analgesics (ASA, acetaminophen)
- **triptans
- Dihydroergotamine
- Mg, riboflavin, feverfew
b. prophylactic-prevent future HA; daily meds
- OCP
- beta blockers (Propranolol)
- CCB (Verapamil)
- TCA (amitriptyline)
- Anticonvulsants (Valproate, Gabapentin, Topiramate)

Question 9

traction HA

Answer 9

• usually after LP d/t persistent leak of CSF
• is a positional HA, relieved when lying flat
• fix with epidural blood patch

Question 10

pseudotumor cerebri

Answer 10

• obese, papilledema on exam d/t inc ICP can lead to blindness
• LP: CSF at v. high pressure
• tx: weight loss, acetazolamide which inhibits CSF production, or a sx shunt

Question 11

temporal arteritis

Answer 11

nonspecific HA in elderly

• immune mediated inflamm
• may be accompanied by polymyalgia, very elevated ESR
• confirmed by bx of temporal artery and prompt corticosteroid tx to prevent blindness

Question 12

trigeminal neuralgia

Answer 12

sudden brief repeated lightening jabs of pain in territory of a branch of the trigeminal nerve

Question 13

HA emergencies and inc ICP

Answer 13

• meningitis-fever, and severe neck stiffness
• SAH-no fever
• inc ICP-n/v/dimming of vision

Question 14

contraindications to LP

Answer 14

• bleeding d/o
• local infection at puncture site
• signs of intracranial mass lesion

Question 15

what are the usual mass lesions producing HA

Answer 15

• brain hemorrhages
• tumors
• abscesses

Question 16

abortive migraine therapies

Answer 16

• triptans
• NSAIDs (Naproxen)
• Acetaminophen
• Antiemetics (Metoclopramide, Prochlorperazine)
• Ergots (Dihydroergotamine)

Question 17

preventive migraine therapies

Answer 17

• topiramate
• divalproex sodium
• TCA
• Beta blockers (propranolol)

Question 18

different HA

Answer 18

HA that are new or diff in character from prior tht present on awakening and are associated with frequent n/v and blurry vision are concerning for pathological cause
-evaluate early with MRI of the brain