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08 Neuro > Headache > Flashcards

Headache Flashcards

1
Q

most common type of headache

A

tension type headache

2nd: headache from systemic infection

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2
Q

physiology of pain

A

peripheral nociceptors are stimulated in response to tissue injury, visceral distention, or other factors
pain producing pathways in CNS/PNS are damaged or activated inappropriately

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3
Q

areas of referred pain

A

MMA = retroorbital
proximal mca/aca = temporal
supratentorial structures = ant 2/3 of head
infratentorial structures = vertex, back of head and neck

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4
Q

most common primary headache syndromes

A

migraine
tension type headache
cluster headache

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5
Q

ichd diagnostic criteria for migraine without aura

A

at least 5 attacks with criteria:
headaches 4-72 hrs, untreated or unsuccessfully treated
>/= 2 of the following: unilateral, pulsating, moderate-severe, aggravation or causing avoidance of routine physical activity
>/=1 of the following DURING:
nausea or vomiting
photophobia and phonophobia
no better diagnosis

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6
Q

ichd diagnostic criteria for migraine with aura

A

at least 2 attacks fulfilling b and c
>/= 1 of the ff reversible symptoms: visual, sensory, speech and/or language, motor, brainstem, retinal
at least 2:
***

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7
Q

diagnostic criteria for chronic migraine

A

> 15 days/month for > 3 mos
fulfill migraine with our without aura criteria
**

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8
Q

indications for preventive treatment in migraine

A

as prophylaxis
4x/month
moderate to severe
excessive use of symptomatic treatment without relief

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9
Q

most common medications for preventive treatment of migraine

A 
tca (amitriptyline)
b blockers
anticonvulsants (topiramate)
flunarizine
botulinum toxin
cgrp monoclinal antibodies (erenumab)
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10
Q

characteristics of abortive treatments for migraine

A

better is used at onset
must not be abused, can cause rebound headache
do not give more than 3 days/week

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11
Q

most common acute/abortive treatment for migraine

A

sumatriptan
ergots (DHE nasal spray, DHE injection)
cgrp receptor antagonists

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12
Q

diagnostic criteria for cluster headache

A

5 attacks
severe or very severe unilateral orbital, supraorbital, or temproal pain, 15-180 mins if untreated

either or both:
1 at least 1: conjunctival injection and/or lacrimation, nasal congestion and/or rhinorrhea, eyelid edema, forehead and facial sweating/flushing, fullness in ear, miosis and/or ptosis
2 restlessness/agitation

frequency between one every other day and 8/day fore than 1/2 time disorder is active

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13
Q

abortive treatments for cluster headache

A

100% oxygen via face mask for 10-15 mins

verapamil 80 mg qid + ecg

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14
Q

preventive treatments for cluster headache

A

single dose ergotamine or serotonin agonist
verapamil 480 mg/day
lithium
prednisone 75 mg daily x3 d

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15
Q

types of tension type headache

A

episodic types: peripheral pain mechanisms

chronic type: central pain

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16
Q

most significant abnormal finding in tension type headache

A

increased pericranial tenderness (interictally, exacetbated during acutal headache, increases with the intensity and frequency of headaches)

17
Q

diagnostic criteria for tth

A

10 episodes
30 min-7 days
>/= 2: bilateral, pressing/tightening, mild-moderate, not aggravated by routine physical activity

both: no nausea or vomiting, no more than one photophobia or phonophobia

18
Q

types of episodic tth

A

infrequent: <1 d/month or <12 d/year
frequent >/= 1 but <15 d/month for >/= 3 mos
>/= 12 and < 180 days/year

19
Q

diagnostic criteria for chronic tth

A

same except for

headache occurring on >/= 15 d/month on ave for >3 mos

20
Q

causes of tth

A

hunger, lack of sleep, stress, overexertion, depression and anxiety, dehydration

21
Q

treatment for tth

A

paracetamol or nsaids
anxiolytics and antidepressants
non-pharmacologic

22
Q

red flag signs for headache

A 
systemic symptoms and disease
neurological symptoms
onset (thunderclap, sudden)
older (>50 yo)
secondary illnesses
23
Q

indications for lp

A

first and worst ha of patient’s life (subarachnoid hemorrhage)
severe, rapid-onset, recurrent HA (subarachnoid hemorrhage)
progressive ha
unresponsive, chronic intractable ha

24
Q

characteristics of subarachnoid hemorrhage

A

table 7

25
Q

characteristics of arterial dissection

A

table 8

26
Q

characteristics of bacterial meningitis

A

table 9

27
Q

characteristics of brain tumor

A

table 10, seizure common presentation

28
Q

characteristics of post-traumatic headache

A

milder, within 7 days of injury

similar to migraine or tension type headache

29
Q

characteristics of giant cell arteritis

A

table 11

elevated crp

30
Q

giant cell arteritis can lead to ___

A

stroke or blindness

31
Q

tx for giant cell arteritis

A

corticosteroids

32
Q

tx for cn neuropathies

A

gabapentin
pregabalin
carbamazepine

33
Q

characteristics of trigeminal neuralgia

A

brief (secs to mins)
severe, sharp, stabbing
unilateral (bilateral = MS)
asymptomatic between attacks, normal facial sensation on PE

spontaneous or evoked pain with cutaneous trigger zones

34
Q

characteristics of glossopharyngeal neuralgia

A

brief (secs to mins)
sharp, jabbing pain in throat, tongue, ear, tonsils

caused by small bv pressing on nerve on brainstem or cn 9

35
Q

tx for glossopharyngeal neuralgia

A

respond to anticonvulsant drugs (carbamazepine and gabapentin)
surgery when unresponsive to therapy

36
Q

location of herpes zoster opthalmaticus

A

ophthalmic division of trigeminal nerve

37
Q

presentation of hz ophthalmaticus

A

periorbital vesicular rash distributed to affected dermatome
conjunctivitis, keratitis, uveitis, and ocular cranial nerve palsies
hutchinson’s sign (vesicles)

38
Q

characteristics of hz oticus (ramsay hunt syndrome)

A

acute peripheral facial neuropathy associated with erythematous vesicular rash at ear canal, auricle, and/or mucous membrane of oropharynx

can also occur without skin rash (zoster sine herpete)

39
Q

characteristics of tolosa hunt syndrome

A

severe unilateral, periorbital headache with painful ophthalmoplegia +/- pupillary abnormalities

inflammation in cavernous sinus or superior orbital fissure

08 Neuro (24 decks)

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