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Neuro 2 (Mo) > Headache (HA) > Flashcards

Headache (HA) Flashcards

1
Q

Recognize the epidemiological implications of headache

A

50% visits with HA c/o and 15% of US population seeking care

$50 Billion/year missed work + medical benefits – US

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2
Q

_____________ 2nd and 3rd most prevalent diseases worldwide

Migraine: 7th most disabling condition of all, 4th in women

A

TTH and Migraine:

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3
Q

Consider _______ in ER HA

A

Blood vessels- can be blocked, inflamed, etc

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4
Q

Stimulation of ______ often leads to pain

A

Trigeminal

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5
Q

______ % Of HA have no known cause

A

90%

Need to rule out 10% 2o

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6
Q

Episodic Migraine: Criteria

A

5 episodes, 4 - 72 hours

2 of the following: unilateral, pulsating, moderate or severe, incr w/ physical activity

1 of the following: NV, photo & phonophobia

Botox injections: for chronic migraine

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7
Q

Migraine Aura: Criteria

A

2 episodes

Reversible s/s of 1 of following:
visual, motor, sensory, brainstem, language, retinal

And 2 of the following:
homonymous visual field or 
unilateral sensory change
gradual development >5 min
symptom lasts 5-60 min
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8
Q

Migraine: Abortive Treatment

A

Aspirin, acetaminophen, NSAIDs

Combination:
- ibuprofen/caffeine*/aspirin

  • Triptans (e.g. sumatriptan or Imitrex)
    - 5-HT 1B/1D agonists
  • Ergotamine derivative (e.g. DHE)
    - nonselective 5-HT agonists
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9
Q

Migraine: Prophylactic Treatment

A

BB, CCB
Tricyclic Antidepressants
Anti-epileptics

alt: sleep, B2

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10
Q

_____ RX: for chronic migraine

A

Botox injections

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11
Q

Tension-type HA: Criteria

A

10 episodes, 30 min – 7 days
2 of: Pressing/ tightening, Mild – Moderate
Bilateral, Not aggravated by PA

Both: No NV, one /none: photophobia or phonophobia

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12
Q

Don’t perform neuroimaging studies in patients with stable headaches that meet criteria for ____________

A

migraine

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13
Q

Don’t perform computed tomography (CT) imaging for headache when _____________ is available, except in emergency settings.

A

magnetic resonance imaging (MRI)

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14
Q

Don’t recommend _________ of migraine trigger points outside of a clinical trial

A

surgical deactivation

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15
Q

Don’t prescribe _________ medications as first-line treatment for recurrent headache disorders.

A

opioid or butalbital-containing

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16
Q

Don’t recommend prolonged or frequent use of _______________ for headache

A

over-the-counter (OTC) pain medications

17
Q

Cluster Headache: Criteria

A

5 episodes
Severe, unilateral, periorbital and/or temporal,15-180 min
1 every other day up to 8/day

1 of the following:* 
	conjunctival injection
	lacrimation
	nasal congestion
	rhinorrhea
	eyelid edema
	ptosis             
	miosis	  
	facial swelling
        ear fullness
	restless/agitation
18
Q

Cluster Headache Epidemiology

A

Men:Women - 4:1

Triggers

  • alcohol
  • vasodilators
19
Q

Cluster HA Treatment

A
  • abortive: oxygen, triptans inj, ergots
    preventive: CCB, Lithium*, Antiepileptics
  • transitional: steroids, nerve blocks
20
Q

Trigeminal Neuralgia Criteria:

A
21
Q

Trigeminal Neuralgia

A

Idiopathic (primary)
Vascular compression (secondary)
Demyelination – multiple sclerosis (secondary)

22
Q 
•	Infection of meninges
•	S/s
–	HA
–	Fever
–	Stiff Neck
–	NV
–	AMS
–	Kernig/Brudzinski signs
A

Meningitis

23
Q

• Most common cause of sudden, intense, incapacitating HA

•	Associated symptoms
–	Stiff neck
–	Photophobia
–	Nausea/vomiting
–	Neurologic findings/obtundation

• Mechanism
– Trauma
– Ruptured aneurysm (80%)
– Arteriovenous malformation

• Up to 50% mortality rate

A

Subarachnoid Hemorrhage

24
Q 
•	Inflammation of vessel wall 
•	Risk Factor: Age >60 years (70-80 yrs)
•	s/s
–	Jaw claudication
–	Temporal artery tenderness
–	Vision loss (optic nerve infarct)
–	Joint pain
–	fever, malaise, wt loss
A

Giant cell

25
Q
  • Exertional HA
  • Retrobulbar Pain
  • NV
  • Pulsatile Intracranial Noises
  • Transient Visual Obscurations
  • Photopsia
  • Diplopia
  • Vision Loss
A

Idiopathic intracranial htn

26
Q

Meningitis

A 
•	Infection of meninges
•	S/s
–	HA
–	Fever
–	Stiff Neck
–	NV
–	AMS
–	Kernig/Brudzinski signs
27
Q

Idiopathic intracranial htn

A
  • Exertional HA
  • Retrobulbar Pain
  • NV
  • Pulsatile Intracranial Noises
  • Transient Visual Obscurations
  • Photopsia
  • Diplopia
  • Vision Loss
28
Q

Subarachnoid Hemorrhage

A

Most common cause of sudden, intense, incapacitating HA

•	Associated symptoms
–	Stiff neck
–	Photophobia
–	Nausea/vomiting
–	Neurologic findings/obtundation

• Mechanism
– Trauma
– Ruptured aneurysm (80%)
– Arteriovenous malformation

• Up to 50% mortality rate

29
Q

Red Flag SNOOP

A 
Systemic symptoms
Neuro sym.
Onset: sudden
Older (>50)
Previous HA hx
30
Q

SAH: Diagnosis/Treatment

A

CT scan – Sensitive at detecting SAH

100%

31
Q

Giant Cell Arteritis: Treatment

A

Glucocorticoids
High dose (e.g. 1 mg/kg Prednisone)
>1 year when vision loss is present

Neuro 2 (Mo) (25 decks)

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