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NMSP Exam II > Headache > Flashcards

Headache Flashcards

1
Q

Secondary headaches are a sign of?

A

Organic disease

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2
Q

What are the 10 worrisome signs which may indicate headache of pathologic origin (secondary HA)?

A
  1. “Worst HA”
  2. Onset of HA after age 50
  3. Atypical HA for patient
  4. HA w/ fever
  5. Abrupt onset (max. intensity in sec. to min.)
  6. Subacute HA w/ progressive worsening over time
  7. Drowsiness, confusion, memory impairment
  8. Weakness, ataxia, loss of coordination
  9. Paresthesias/Sensory loss/ Paralysis
  10. Abnormal medical or neurological exam
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3
Q

Any patient presenting with a headache who has a “worrisome history” or abnormal examination needs what?

A
  • Urgent imaging study
  • Perhaps even a L.P. and possibly arteriogram
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4
Q

Differentiate a common migraine from a classic migraine.

A
  • Common migrarine = without aura
  • Classic migraine = with aura
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5
Q

What is the intensity, age of peak prevalence, and gender ratio for common migraines?

A
  • Intensity: moderate to severe
  • Prevalence peaks between 35-40 years
  • Gender ratio: F:M = 3:1
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6
Q

What is the location, patient description of pain, and patient behavior with a common migraine?

A
  • Location: unilateral or bilateral
  • Description: throbbing/sharp/pressure
  • Behavior: retreat to dark, quiet room
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7
Q

What are the 4 most common associated symptoms with a common migraine?

A
  • Nausea
  • Vomiting
  • Photophobia
  • Phonophobia
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8
Q

How long does the aura associated with Classic Migraines usually last?

A

Usually 15-30 mins, but sometimes longer

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9
Q

What are the common visual symptoms associated with Classic Migraines?

A
  • Scintillations: flashes of light
  • Scotoma: an interruption or break in the visual field (blind spots)

*Often hemianopic

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10
Q

The most widely discussed theory about the cause of migraines says that they are caused by?

A

Neurogenic inflammation

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11
Q

To be defined as a chronic migraine which criteria must be met?

A

Headache for 15 or more days/month, lasting 4 hours or longer, for a period of at least 3 months

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12
Q

What is the intensity and disability caused by Tension-Type HA’s?

A
  • Intensity: Mild to Moderate
  • Disability: May inhibit, but does NOT prohibit daily activities
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13
Q

What is the common location, patient description of pain, and is there an associated aura/prodrome with a Tension-Type HA?

A
  • Location: bifrontal, bioccipital
  • Description: dull, aching, squeezing, pressure
  • No prodrome or aura
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14
Q

Which type of headache has an association with sleep apnea as a comorbidity?

A

Cluster HA

*This will be on the exam!

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15
Q

What is the intensity and gender ratio for Cluster HA?

A
  • Intensity: severe, excruciating
  • Gender ratio: F:M = 1:6
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16
Q

In regards to monthly frequency what constitutes an episodic type vs. chronic type of Cluster HA?

A
  • Episodic type: 1 or more attacks/day for 6-8 weeks
  • Chronic type: several attacks per week without remission
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17
Q

What is the most common location/distribution of Cluster HA’s?

A
  • 100% unilateral
  • Generally orbitotemporal
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18
Q

Frenetic, pacing, and rocking behaviors are most often associated with what type of headache?

A

Cluster HA

19
Q

What are some of the associated symptoms of Cluster HA’s?

A
  • Ipsilateral ptosis
  • Miosis
  • Conjunctival injection
  • Lacrimation
  • Stuffed or runny nose
20
Q

What is the normal duration for a Cluster HA?

A
  • 30 minutes to 2 hours
  • Classic is 45 min
21
Q

What are the 5 primary types of HA?

A
  1. Classic migraine
  2. Common migraine
  3. Chronic migraine
  4. Tension type HA
  5. Cluster HA
22
Q

What is the only FDA approved treatment for chronic migraines?

A

BOTOX injections

23
Q

What are some underlying conditions which are contraindications for the use of Triptans in the acute treatment of migraines?

A
  • Ischemic heart disease
  • Cardiovascular, cerebrovascular, or peripheral vascular disease
  • Raynaud’s syndrome
  • Uncontrolled HTN
  • Hemiplegic or basilar migraine
  • Severe renal or hepatic impairment
24
Q

Which agent/therapy can be used to break the cycle of a prolonged migraine or several weeks of frequent migraines?

Also, a good treatment for people who get in frequent cluster HA’s?

A

A prednisone taper

25
Q

What’s Trigeminal Neuralgia?

Treatment?

A
  • Excruciating sharp, shooting, electrical quality pain occuring in paroxysms in one or more distributions of the trigeminal nerve, often freqent through the day
  • Treatment is usually carbamazepine or oxcarbamazepine
26
Q

A group of headache disorders characterized by unilateral trigeminal distribution pain that occurs in association with prominent ipsilateral cranial autonomic features, describes what?

A

Trigeminal autonomic cephalgia (TAC’s)

27
Q

What 5 types of headache disorders are classified as Trigeminal Autonomic Cephalgias (TAC’s)?

A
  1. Cluster HA
  2. Paroxysmal hemicrania
  3. Hemicrania continua
  4. SUNCT syndrome
  5. SUNA syndrome (similar to SUNCT, but with autonomic sx’s)
28
Q

What are the characteristics of SUNCT syndrome?

Location?

Onset and which sex is most commonly affected?

A
  • Shortlasting, unilateral, neuralgiform headache attacks w/ conjunctival injection and tearing
  • Excruciating, burning, stabbing electrical HA in periorbital area lasting seconds to a few mins, occuring frequently throughout the day
  • Onset typically over 50 in men
29
Q

What is the treatment for SUNCT syndrome?

A
  • Usually anticonvulsants
  • Particularly lamotrigine
30
Q

Which HA type is very similar to cluster HA, but shorter duration (often only a few mins) and increased frequency (usually >5 times per day)?

A

Paroxysmal Hemicrania

31
Q

Paroxysmal Hemicrania (HA) is exquisitely reponsive to which drug?

A

Indomethacin

32
Q

As a general rule, many physicians (including neurologists) believe that any person with HA should have what type of evaluation?

A

A one-time, thorough neuroimaging study (CT head with AND w/o contrast or MRI of head)

33
Q

What’s a good oral tx for someone experiencing multiple cluster HA’s in a year?

A

Verapamil (Ca2+ channel blocker)

34
Q

What medication is known to cause meningitis?

A

lamotrigine

(IVIg)

35
Q

If a pt presents with s/s of meningitis, and you are unable to get an immediate LP, what should you do?

A

draw blood

give dexamethasone, ceftriazon IV, vancomycin IV

switch up to more specific tx once resutls are in

36
Q

What are the key features of HSV1 Encephalitis?

A

fever, HA, impaired consiciousness seizures, focal neuro s/s

focal abnormalities in temporal lobes

tx: acyclovir

*up to 25% can develop recurrent neuropsychiatric sx (sometimes with associated ABs with secondary AI encephalitis)

37
Q

What should be on the ddx if a pt presents with rapidly progressive encephalopathy or psych disturbances?

A

AI Encephalitis

especially if assoc with seizures!! –> some are well known causes of intractable epilepsy

38
Q

How is AI Encephalitis typically tx?

A

combo of immune therapies:

high dose steroids

IVIg

plasma exhange

rituximab

cyclophosphamide

other immunosuppressive agents

39
Q

Who does NMDA Encephalitis typically affect? What s/s are present?

A

young or middle aged women

rapid onset (<3 mo) of 4 of the following 6:

  • abnormal psych behavior or cognitive dysfunction
  • speech dysfunction
  • seizures
  • movement disorders, dyskinesias, rigidity/abnormal postures
  • dec level of consciousness
  • autonomic dysfunction or central hypventilation
40
Q

To dx NMDA Encephalitis, you need at least one of what two tests?

A

abnormal EEG (focal or diffuse or slow or disorganized activity, epileptic activity, or extreme delta brush)

CSF with pleocytosis or oligocloncal bands and/or NMDA R ABs

41
Q

What is NMDA Encephalitis commonly associated with?

A

teratoma

42
Q

What is a hallmark of LGI1 Encephalitis?

A

more common in men

faciobrachial dystonic seizures (brief, involve one side of face and ispi arm)

sleep disturbance

may see temporal lob abnormality in some pts acutely

43
Q

Why is it important to tx LGI1 Encephalitis?

A

failure to tx results in permanent brain damage (esp short term membory)

even with tx, 1/3 relapse

*faciobrachial seizures do NOT respond to AEDs*

NMSP Exam II (17 decks)

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