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Clinical Med - Neurology > Headache / Concussion > Flashcards

Headache / Concussion Flashcards

1
Q

What is the most common sports-related TBI?

A

Concussions

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2
Q

The transient brain dysfunction in concussions is related to the excessive release of what?

A

Excitatory neurotransmitter release (particularly glutamate)

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3
Q

What are the most common acute symptoms in concussions?

A 
Headache*
Nausea
Dizziness
Confusion 
Memory impairment
Incoordination 
Attention problems 
Behavioral changes
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4
Q

T/F: LOC is a requirement for concussion diagnosis

A

False

It is not a requirement

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5
Q

What would constitute a Grade 1 concussion?

Grade 2?

Grade 3?

A

Grade 1: - LOC, Sx and amnesia resolve in under 30 minutes

Grade 2: + LOC for less than 1 minute, Sx and amnesia lasting less than 1 week

Grade 3: + LOC for longer than 1 minute, Sx and amnesia for longer than 1 week

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6
Q

Are brain structural abnormalities seen on imaging in concussion patients?

A

No

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7
Q

When would imaging be warranted in a patient with a concussion?

A 
\+ LOC
Focal neural deficits
Persistent AMS
Skull Fractures
2+ episodes of emesis
> 65 y.o.
Serious Trauma (MVA, Fall) 
EtOH Use
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8
Q

What is the most critical portion of concussion treatment?

A

The first 10 days

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9
Q

Patients with concussions often benefit from ___ hours of direct observation.

A

4 Hours

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10
Q

Concussion patients should have a follow up visit for neurological check within the first ___ hours of diagnosis.

A

24 hours

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11
Q

Athletes with a single concussion can return to sports after being asymptomatic for longer than ___ ______.

A

1 week

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12
Q

If concussion symptoms last longer than 1 year after diagnosis, they are considered to have what syndrome?

A

Post-concussive syndrome

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13
Q

Would an MRI be warranted if a patient continued to experience concussive symptoms for for longer than 1 year?

A

Yes (r/o other causes)

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14
Q

What is a complication often associated with concussions?

A

Chronic Traumatic Encephalopathy

Dementia Pugilistica

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15
Q

Which type of headache is best described below……

Unilateral
Pulsating
Interferes with ADLs
Nausea
Photophobia / Phonophobia 
No Prodrome
A

Migraine without Aura

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16
Q

Can migraines without aura be related to menstrual cycles?

A

Yes….

Catamenial Migraines

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17
Q

What is commonly described on an EEG of a patient with migraines?

A

Cortical spreading depression

18
Q

T/F: Oligaemia is seen in patients with migraines without aura

A

False

Oligaemia is seen in patients with migraines with aura

19
Q

What is the most common aura patients with migraines will experience?

What are examples of these?

A

Visual

Examples:

Zig-Zag Pattern
Scotoma

20
Q

Other than visual, what are examples of auras migraine patients may experience?

A 
Sensory Disturbances (ie: pins and needles) 
Speech Disturbances (Aphsia) 
Hemiplegic Weakness
21
Q

Why is it important to have patients document their auras, including onset, presentation, and duration?

A

This can help distinguish between migraines and CVA

22
Q

Which type of headache is best described below……

Visual changes lasting 20 minutes prior to resolution with associated tingling in the left arm which resolves prior to the onset of the headache

A

Migraine with aura

23
Q

T/F: Migraines can be bimodal

A

True

24
Q

What are the top THREE most common migraine triggers?

A
  1. Stress
  2. Hormones (Women > Men)
  3. Not Eating

Others include….

Weather
Sleep Disturbance
Odors
Lights
Alcohol
Smoking
Exercise
25
Q

When would an MRI be warranted in a patient with a history of migraines?

A
  1. Change in HA character
  2. Change in frequency
  3. New headache type
  4. No longer resolving with medications
26
Q

If a patient complains of > 8-9 headahce days per month than it would be best to consider what medications?

What are examples of these?

A

Preventative

Anti-HTN: Propanolol*, Verampamil

Anti-Depressants: Amitriptyline*

Anit-Epileptic: Topiramate, Depakote

27
Q

What are examples of abortive migraine treatments?

A

NSAIDs
Antiemetics (Metoclopromide)
Triptans (Sumatriptan)
DHE

28
Q

If a migraine lasts for longer than 72 hours is is considered what?

A

Status migrainosus

29
Q

Which type of headache is best described below……

Band-like pressure
Dull
Precipitated by stress
~ 30 minute duration
No photophobia, nausea
A

Tension HA

30
Q

Less than one tension headache a month would be considered what subtype of tension headaches?

A

Infrequent Episodic

31
Q

More than 15 tension headache days a month would be considered what subtype of tension headaches?

A

Chronic

32
Q

1 -14 tension headache days a month would be considered what subtype of tension headaches?

A

Frequent Episodic

33
Q

What is the most common trigger in tension headaches?

A

Stress

34
Q

T/F: Tension headache patients often have a completely normal neurological evaluation and work up

A

True

35
Q

Where may you be able to find muscular tenderness in tension headache patients?

A

Pericrainal

Neck

36
Q

How are acute tension headaches treated?

A

Heat, Ice, Massage, Rest

ASA, Acetaminophen, Ibuprofen, or Naproxe

37
Q

What medications can be used for tension headache prevention?

A

Anti-depresants: Amitriptyline, Mirtazapine

Anticonvulsants: Topiramate, Gabapentin

Muscle Relaxants

38
Q

Which type of headache is best described below……

Male
Unilateral (Temporal, Periorbital) 
Sharp, Stabbing
Red Eye, Tearing 
Same time every day
Pacing Around
A

Custer HA

39
Q

What are common triggers of cluster HA?

A

Alcohol
Histamine
Nitroglycerin

40
Q

What is given as abortive treatment for cluster headaches?

Preventative treatment?

A

Abortive:

Oxygen
Triptan
Intranasal Lidocaine

Preventative:

Verapamil

Clinical Med - Neurology (7 decks)

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