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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
chronic paroxysmal hemicrania
- "indomethacin-responsive HAs" - less common than cluster - "atypical cluster HA"
26
categories of migraines
with an aura- "classic" | without an aura- "common"
27
who gets migraines
women>men 25-45 y/o familial predisposition >50%
28
what type of HA is a migraine?
vascular HA | - caused by blood vessel abnormalities, which alternately constrict and open blood vessels in the head
29
migraine prodromes
24-48 hours prior to onset | - 60% people get it
30
examples of migraine prodromes
``` euphoria depression irritability cravings yawning ```
31
migraine aura
15% experience | - focal neurologic symptom preceding the HA by no more than an hour
32
most common migraine aura
scantillating scotomata - homonymous visual and/or unilateral sensory symp - develops over 5 min - 5-60 mins - due to regional reduction in blood flow
33
common migraine
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
classic migraine
fulfills criteria for common migraine but also: - at least 2 HA associated with aura
35
ocular migraine
- aura but no headache | - unilat, lasts 10-60 min
36
general prevention of migraine HA
avoid triggers -OCP in women not good (especially in classic-contraindicated)
37
pharm prevention of migraine HA
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
food triggers of migraine
tyramine containing foods alcohol nitrates cold foods (ice cream)
39
acute migraine tx
mild-NSAIDS mod- triptans or ketorolac very severe:dihydroergotamine or opioid IV/SC in combo with antiemetic
40
causes of secondary headaches
trauma & vascular disorders - cranial neuralgias or nerve damage - metabolic disorder - substance use or withdrawl - non-intracranial infection - nonvascular intracranial disorder
41
temporal arteritis
- 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
chiari malformation
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
pseudotumor cerebri
- LP opening pressure is elevated | - papiledema, visual field loss, 6th nerve palsy
44
pseudotumor cerebri risk factors
obese women of childbearing age | female, fat, fertile and forty
45
medications that can cause pseudotumor cerebri
- hypervitaminosis A and D - retinoids - oral contraceptives - growth hormone - tetracyclines
46
treatment of pseudotumor cerebri
- stop offending meds - weight loss - acetazolamide to reduce CSF production (plus/minus furosemide) - pallative serial LP
47
headache red flags
- 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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