Headache / Concussion Flashcards
What is the most common sports-related TBI?
Concussions
The transient brain dysfunction in concussions is related to the excessive release of what?
Excitatory neurotransmitter release (particularly glutamate)
What are the most common acute symptoms in concussions?
Headache* Nausea Dizziness Confusion Memory impairment Incoordination Attention problems Behavioral changes
T/F: LOC is a requirement for concussion diagnosis
False
It is not a requirement
What would constitute a Grade 1 concussion?
Grade 2?
Grade 3?
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
Are brain structural abnormalities seen on imaging in concussion patients?
No
When would imaging be warranted in a patient with a concussion?
\+ LOC Focal neural deficits Persistent AMS Skull Fractures 2+ episodes of emesis > 65 y.o. Serious Trauma (MVA, Fall) EtOH Use
What is the most critical portion of concussion treatment?
The first 10 days
Patients with concussions often benefit from ___ hours of direct observation.
4 Hours
Concussion patients should have a follow up visit for neurological check within the first ___ hours of diagnosis.
24 hours
Athletes with a single concussion can return to sports after being asymptomatic for longer than ___ ______.
1 week
If concussion symptoms last longer than 1 year after diagnosis, they are considered to have what syndrome?
Post-concussive syndrome
Would an MRI be warranted if a patient continued to experience concussive symptoms for for longer than 1 year?
Yes (r/o other causes)
What is a complication often associated with concussions?
Chronic Traumatic Encephalopathy
Dementia Pugilistica
Which type of headache is best described below……
Unilateral Pulsating Interferes with ADLs Nausea Photophobia / Phonophobia No Prodrome
Migraine without Aura
Can migraines without aura be related to menstrual cycles?
Yes….
Catamenial Migraines
What is commonly described on an EEG of a patient with migraines?
Cortical spreading depression
T/F: Oligaemia is seen in patients with migraines without aura
False
Oligaemia is seen in patients with migraines with aura
What is the most common aura patients with migraines will experience?
What are examples of these?
Visual
Examples:
Zig-Zag Pattern
Scotoma
Other than visual, what are examples of auras migraine patients may experience?
Sensory Disturbances (ie: pins and needles) Speech Disturbances (Aphsia) Hemiplegic Weakness
Why is it important to have patients document their auras, including onset, presentation, and duration?
This can help distinguish between migraines and CVA
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
Migraine with aura
T/F: Migraines can be bimodal
True
What are the top THREE most common migraine triggers?
- Stress
- Hormones (Women > Men)
- Not Eating
Others include….
Weather Sleep Disturbance Odors Lights Alcohol Smoking Exercise
When would an MRI be warranted in a patient with a history of migraines?
- Change in HA character
- Change in frequency
- New headache type
- No longer resolving with medications
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?
Preventative
Anti-HTN: Propanolol*, Verampamil
Anti-Depressants: Amitriptyline*
Anit-Epileptic: Topiramate, Depakote
What are examples of abortive migraine treatments?
NSAIDs
Antiemetics (Metoclopromide)
Triptans (Sumatriptan)
DHE
If a migraine lasts for longer than 72 hours is is considered what?
Status migrainosus
Which type of headache is best described below……
Band-like pressure Dull Precipitated by stress ~ 30 minute duration No photophobia, nausea
Tension HA
Less than one tension headache a month would be considered what subtype of tension headaches?
Infrequent Episodic
More than 15 tension headache days a month would be considered what subtype of tension headaches?
Chronic
1 -14 tension headache days a month would be considered what subtype of tension headaches?
Frequent Episodic
What is the most common trigger in tension headaches?
Stress
T/F: Tension headache patients often have a completely normal neurological evaluation and work up
True
Where may you be able to find muscular tenderness in tension headache patients?
Pericrainal
Neck
How are acute tension headaches treated?
Heat, Ice, Massage, Rest
ASA, Acetaminophen, Ibuprofen, or Naproxe
What medications can be used for tension headache prevention?
Anti-depresants: Amitriptyline, Mirtazapine
Anticonvulsants: Topiramate, Gabapentin
Muscle Relaxants
Which type of headache is best described below……
Male Unilateral (Temporal, Periorbital) Sharp, Stabbing Red Eye, Tearing Same time every day Pacing Around
Custer HA
What are common triggers of cluster HA?
Alcohol
Histamine
Nitroglycerin
What is given as abortive treatment for cluster headaches?
Preventative treatment?
Abortive:
Oxygen
Triptan
Intranasal Lidocaine
Preventative:
Verapamil
