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Clin Med-Neuro > Headache > Flashcards

Headache Flashcards

1
Q

definition of a tension HA

A

recurrent HA lasting 30 min-7 days w/o N/V/focal neurological deficits

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2
Q

characteristics of tension HA

A
  • non-throbbing
  • mild-mod
  • bilateral
  • not aggravated by routine physical activity
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3
Q

who gets tension headaches

A
  • women>men
  • second decade of life
  • young
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4
Q

tension HA triggers

A

result from the contraction of neck and scalp muscles caused by:

  • stress, de/anxiety
  • glare and eye strain
  • fatigue
  • hunger
  • noise
  • alcohol/smoking/caffeine
  • recent colds
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5
Q

Acute treatment of tension HA

A

-non-narcotic analgesics with limited frequency to prevent rebound HA

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6
Q

non-pharm tx of tension HA

A

relaxation training
TENS
physical therapy
massage

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7
Q

chronic tx of tension HA

A

prophylaxis: tricylic antidep, low dose BB, SSRIs

- no narcotics, limit nsaids, consider indomethacin

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8
Q

exertional HA

A

arise during or after physcial activity

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9
Q

characteristic of exertion HA

A
  • bilateral
  • throbbing/pulsatile
  • 5min to 2 days
  • nausea
  • mod/severe
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10
Q

types of exertion HA

A

primary and secondary

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11
Q

primary exertion HA

A

usually benign; more common

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12
Q

secondary exertion HA

A

symptomatic of intracranial disease; less common

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13
Q

when are neuro-imaging studies warranted in cases of exertion HA

A

all cases

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14
Q

who gets coital cephalgia (HASA)

A

male predominance

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15
Q

type 1 HASA

A
  • bilateral
  • occipital
  • pressure gradually increases with increasing sexual excitement
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16
Q

type 2 HASA

A
  • sudden, profound just prior to orgasm
  • start occipitally but can generalize
  • similar in character to SA hemorrhage
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17
Q

type 3 HASA

A

holo-cephalic

  • positional
  • clinical features of low CSF pressure HA
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18
Q

symptoms of cluster HA

A
  • severe unilateral orbital,supraorbital and/or temporal pain
  • 15-180 min if untreated
  • every other day to 8 per day during attack clusters
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19
Q

what accompanies cluster HA ipsilaterally?

A

conjunctival injection/lacrimation

nasal congestion/rhinorrhea

eyelid edema

forehead/facial sweating

miosis/ptosis

restlessness or agitation

not attributable to another disorder

20
Q

causes of cluster HA

A
  • related to trigeminal nerve parasympathetic activation

- sudden release of histamine or serotonin

21
Q

triggers of cluster HA

A 
smoking
alcohol
glare
stress
foods
22
Q

prophylactic treatment of cluster HA

A

verapamil (drug of choice)

lithium (more se)

prednisone

topiramate (as add-on)

23
Q

nonpharm treatment of cluster HA

A

avoidance of alcohol, histamine, nitroglycerin, tobacco during clusters

24
Q

abortive treatment of cluster HA

A

inhalation of 100% oxygen

  • triptans
  • dihydroergotamine
25
Q

chronic paroxysmal hemicrania

A
  • “indomethacin-responsive HAs”
  • less common than cluster
  • “atypical cluster HA”
26
Q

categories of migraines

A

with an aura- “classic”

without an aura- “common”

27
Q

who gets migraines

A

women>men
25-45 y/o
familial predisposition >50%

28
Q

what type of HA is a migraine?

A

vascular HA

- caused by blood vessel abnormalities, which alternately constrict and open blood vessels in the head

29
Q

migraine prodromes

A

24-48 hours prior to onset

- 60% people get it

30
Q

examples of migraine prodromes

A 
euphoria
depression
irritability
cravings
yawning
31
Q

migraine aura

A

15% experience

- focal neurologic symptom preceding the HA by no more than an hour

32
Q

most common migraine aura

A

scantillating scotomata

  • homonymous visual and/or unilateral sensory symp
  • develops over 5 min
  • 5-60 mins
  • due to regional reduction in blood flow
33
Q

common migraine

A

at least 5 episodes of:

HA lasting 4-72 hours 
- unilateral location (usually bilat)
- pulsating
mod/severe
-aggravated by activity

during HA:

  • N/V
  • photophobia and phono-phobia

no motor weakness

34
Q

classic migraine

A

fulfills criteria for common migraine but also:

  • at least 2 HA associated with aura
35
Q

ocular migraine

A
  • aura but no headache

- unilat, lasts 10-60 min

36
Q

general prevention of migraine HA

A

avoid triggers

-OCP in women not good (especially in classic-contraindicated)

37
Q

pharm prevention of migraine HA

A

beta blockers
tricyclic antidepressants
anticonvulsants

triptans can be used at the onset of the prodrome/HA or at the onset of aura to abort

erenumab- monoclonal antibody

38
Q

food triggers of migraine

A

tyramine containing foods
alcohol
nitrates
cold foods (ice cream)

39
Q

acute migraine tx

A

mild-NSAIDS
mod- triptans or ketorolac
very severe:dihydroergotamine or opioid IV/SC in combo with antiemetic

40
Q

causes of secondary headaches

A

trauma & vascular disorders

  • cranial neuralgias or nerve damage
  • metabolic disorder
  • substance use or withdrawl
  • non-intracranial infection
  • nonvascular intracranial disorder
41
Q

temporal arteritis

A
  • localized
  • tender or palpable temoral artery
  • jaw claudiccation, low grade fever, fatigue, weight loss
  • ESR>50 mm/h
  • dx by biopsy
  • steroid treatment
  • associated polymyalgia rheumatic
42
Q

chiari malformation

A

structural defects in the base of the skull, spinal cord and cerebellum that occur during fetal development as a resut of gene mutations or a maternal diet low in folate

43
Q

pseudotumor cerebri

A
  • LP opening pressure is elevated

- papiledema, visual field loss, 6th nerve palsy

44
Q

pseudotumor cerebri risk factors

A

obese women of childbearing age

female, fat, fertile and forty

45
Q

medications that can cause pseudotumor cerebri

A
  • hypervitaminosis A and D
  • retinoids
  • oral contraceptives
  • growth hormone
  • tetracyclines
46
Q

treatment of pseudotumor cerebri

A
  • stop offending meds
  • weight loss
  • acetazolamide to reduce CSF production (plus/minus furosemide)
  • pallative serial LP
47
Q

headache red flags

A
  • after age 50
  • sudden onset or worst headache ever
  • increasing frequency and severity
  • new onset in a patient with risk factors for HIV or cancer
  • signs of systemic illness (fever, stiff neck, rash)
  • papilledema
  • focal
  • trauma

Clin Med-Neuro (8 decks)

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