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Critical Care I > Headache Lecture > Flashcards

Headache Lecture Flashcards

1
Q

what type of headaches can have a genetic disposition

A

Primary Headaches

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2
Q

type of headache

90% of reported headaches

A

Primary Headaches

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3
Q

You wouldn’t have this headache if it wasn’t for a catalyst or a reason

A

Secondary Headaches

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4
Q

rebound headaches are what type of headache

A

secondary

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5
Q

timeline to define status migrainosus

A

migraine that is unremitting for over 72 hours

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6
Q

episodic syndromes that may be associated with migraine

A

cyclical vomiting syndrome

abdominal migraine

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7
Q

cluster headache symptoms

A 
one sided
tearing
rhinorrhea
ptosis
conjunctival injection

rare in kids

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8
Q

definition of a concussion

A

neurologic symptoms that develop min, hours or even a few days after a head injury

no obvious signs of trauma needed

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9
Q

Cervicogenic headache stems from

A

stems from neck - tight muscles, knots, ect

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10
Q

most common primary headache disorder that people get world wide

A

tension headache

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11
Q

second most common primary headache disorder

A

migraine

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12
Q

nausea and or vomiting
sensitive to noise (phonophobia) or light (photophobia)

what type of headache

A

migraine

tension does not have n/v

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13
Q

location characteristic of migraine vs tension

A

tension - circumferential

migraine (unilateral or bilateral (frontal) location

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14
Q

tension headaches last from

A

30 min to 7 days

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15
Q

migraine attacks last at least

A

2 hours

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16
Q

Auras

A

most are visual
some can be sensory such as parasthesias

Brainstem auras are rare (refer to neuro)

  • Dysarthria
  • Vertigo
  • Tinnitus
  • diplopia
  • motor weakness= hemiplegic migraine
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17
Q

women who have migraine with aura are at greater risk for

A

stroke

no estrogen containing meds due to increased risk

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18
Q

common migraine triggers

A 
stress
food additives: MSG, dyes, aspartame
Cheese (dairy)
chocolate
citrus
nitroglycerine
change in barometric pressure
caffeine withdrawal
fasting/skipping meals
dehydration
menstruation
acute illness
wine/alcohol
19
Q

when is the worst time of year for adolescence and migraine occurrence

A

April and May

20
Q

comorbid conditions r/t migraines

A

Acute or chronic disease processes (DM, Sickle cell, chronic pain disorder)

Orthostatic hypotension/intolerance (POTS or dysautonomia)

Epilepsy

Anxiety, depression, ADHD and/or other psychiatric diagnosis

IBS

Back Pain

TMJ

Concussion history

Thyroid disease

Sleep disorders

Inflammatory disorders such as asthma

21
Q

Pertinent history for headache presentation

A

Age of onset (when was very first headache)

Family history

headache frequency and severity)

Are the headaches escalating in frequency/severity, unchanged over time or improving?

Pain location/and or radiation

Duration (include time during sleep, is it constant/unremitting?)

Pain description (sharp, throbbing, pounding, squeezing, ect)

Warning signs (prodrome or aura)

Associated symptoms ( n/v/sensitivity to light/noise, dizziness/lightheadedness, sensory changes or motor weakness

Triggers

Do headaches worsen with physical activity?

Considerations for females (pregnancy, menstruation, menopause)

22
Q

when do boys usually develop migraines

A

5/6 years old ,usually when they reach puberty they get better

23
Q

when do girls usually develop migraines

A

puberty (menarche)

24
Q

phases of episodic migraines

A

Prodrome (moody, chocolate or maybe sleepy) - few hours to days

Aura - 5-60 min

Migraine attack - 4-72 hours

Postdrome - 24-48 hours (sluggish, hangover like feeling)

25
Q

the key brain structure involved in the production of migraine pain and symptoms

A

brainstem

26
Q

Vital signs part of the focused neurologic exam

A

potential red flag items
BP
HR
Mental Status

others-
Temp
BMI

27
Q

Head/neck part of the focused neurologic exam

A

Potential red flag items
Neck ROM
Carotid bruits (MRA of head and neck)

others
tenderness
pericranial tenderness

28
Q

Cranial nerves part of neurologic exam

A

Fundoscopic exam - looking at margins of the optic disc- if they are blurred that would indicate ICP (optic nerve sheet swelling)

Sensation/coordination

other
Visual acuity and visual fields
Extraocular movements
facial symmetry and sensation intact
palate elevation symmetric and tongue protrudes midline
29
Q

Motor part of neurologic exam

A

Potential red flag
Sensation/coordination
Gait

other
strength/tone
Deep tendon reflexes

30
Q

what is the pneumonic for neurologic red flags

A

SNOOP 5

S - symmetric symptoms or secondary risk factors

N- neurologic signs or symptoms (confusion)

O - onset sudden, abrupt, peak < 1 min (thunderclap, SAH, CVST, dissection)

O - older, greater than age 50 (Giant cell arteritis, glaucoma, cardiac cephalgia)

P- Previous headache history (change in character, severity, frequency or pattern)

P- Postural (intracranial hypertension or low pressure HA/CSF leak)

P - Precipitated by valsalva, exertion - like cough or sneeze (Chiari, space occupying lesion)

P - Pulsatile tinnitus (with diplopia + transient visual changes = intracranial HTN)

P - Pregnancy or post partum (preeclampsia, eclampsia, apoplexy)

31
Q

Neuro Diagnostic imaging

can accurately detect acute SAH or focal bleed

A

Head CT - can accurately detect acute SAH or focal bleed

  • without contrast to detect blood
  • with contract to detect lesions or AVM
32
Q

Neuro Diagnostic imaging

to detect blood

CT with or without contrast?

A

without

33
Q

Neuro Diagnostic imaging

to detect lesions or AVM

CT with or without contrast?

A

With

34
Q

what is the best neuro diagnostic imaging for looking at lesions

A

MRI (Mass or demyelinating)

35
Q

What diagnostic imaging to look for demyelination

A

MRI

36
Q

what neuro diagnostic imaging to look for arterial dissection, AVM or aneurysm

A

MRA head

37
Q

What neuro diagnostic imaging to look for venous sinus thrombosis

A

MRV head

38
Q

what can you order to evaluate for low or high CSF pressure headache, SAH, meningitis

A

Lumbar puncture

can also look for other CSF pathologies

39
Q

what labs for neuro diagnostic

A

Markers of inflammation (ESR and sed rate)

thyroid panel

40
Q

If you have a neg CT, can you still have a concussion

A

yes

41
Q

what labs to order for LP

A

cell count
glucose
protein
cultures

42
Q

which of the following symptoms reported by a pt with acute headache warrants a need for urgent neuroimaging?

a. limited neck flexion on exam with a fever
b. Witnessed LOC
c. Head pain onset with exertion
d. All of the above

A

D. All of the above

43
Q

How do we know this is a primary headache? by characteristics

A

Characteristics of the headache or headache pattern fit classification

Complete resolution of symptoms in between headaches

Not attributed to another disorder

normal neurologic exam

44
Q

Treatment protocol for migraines

A

With Hydration/fluid bolus

1) NSAIDS
- ibuprofen 10mg/kg/dose q 8 hrs
- naproxen 10mg/kg/dose q 12 hrs
- acetaminophen 15mg/kg/dose q 6 hours
- ketorolac 10mg po or 30mg IV q 6-8 hrs

2) Triptans (Serotogeneric agonist selective activity on 5-HT1B, 5-HT1D)
- Sumatriptan, rizatriptan, zolmitriptan, ect.
- available in tablets, ODT, and nasal spray
- Dosed q 2 hrs with max daily dosing of 2-3 tabs in 24 hrs

3) antiemetics/dopamine receptor antagonists
- promethazine
- prochlorperazine
- metoclopramide
- ondansetron
* *beware of extrapyramidal side effects**

4) Magnesium sulfate 1000mg IV over 30 min
5) Sodium valproate 20mg/kg (max 1000mg) IV
6) DHE IV (per protocol)

Critical Care I (27 decks)

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