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MSK II FINAL > Headache Medicine > Flashcards

Headache Medicine Flashcards

1
Q

PrimaryHeadache Disorders

A

Migraine

Tension-type

Trigeminal autonomic cephalalgia

Other

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2
Q

What is Migraine?

A

A heritable syndrome with attacks including light and
noise sensitivity, nausea, disequilibrium, gastrointestinal dysfunction, and headache

12-14% experienced

women 3x more than men

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3
Q

Premonitory symptoms

A

Hours to days
Fatigue
Mood changes
Food cravings
Yawning
Muscle tenderness
Photophobia

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4
Q

Aura

A

5-60 minutes
Throbbing pain
Nausea
Photophobia
Phonophobia
Osmophobia

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5
Q

Postdrome

A

24-48 hours
Fatigue
Cognitive changes
Neck stiffness

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6
Q

Nociceptive neurons that innervate the ___ are believed to release _____

A

dura

vasoactive neuropeptides (e.g., CGRP, PACAP) causing signaling along the trigemino-vascular pathway.

Over time, neurons in this pathway are believed to become sensitized. That is, their threshold for response decreases and the magnitude of their response increases.

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7
Q

Some believe the CSD wave traveling across the brain causes release of ATP, glutamate, potassium, hydrogen ions, CGRP, nitrous oxide that diffuse toward the surface of the brain to activate meningeal nociceptors.

Problems with this theory:

A

Two-thirds of patients with migraine do not experience aura (silent CSD?)

Aura may occur simultaneously with headache

And aura may occur in isolation (without headache).

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8
Q

Tension-Type Headache

A

Pericranial myofascial tissues are more tender in tension-type headache

Tenderness is related to both intensity and frequency of attacks

Multiple electromyographic (EMG) studies have demonstrated normal or slightly increased muscle activity intenstion-type headache

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9
Q

Trigeminal Autonomic Cephalalgias

A

never on the other side

eyes = color changes and watering of eye
> lid can drop

nose = either runny or stuffy

unilateral facial sweating

only on side of headache

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10
Q

Trigeminal Autonomic Cephalalgias

4 stages:

A

short lasting unilateral headaches

paroxysmal hermicrania

cluster headache

HC

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11
Q

short lasting unilateral headaches

A

1-600sec./1-100 attacks daily

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12
Q

paroxysmal hermicrania

A

2-30 mins./1-40 attacks daily

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13
Q

cluster headache

A

15-180 mins./1-8 attacks daily

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14
Q

HC

A

continuous with exacerbation

duration of 3 months

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15
Q

Others

A

Primary cough headache
Primary exercise headache
Primary headache associated with sexual activity
Primary thunderclap headache
Cold-stimulus headache
External-pressure headache
Primary stabbing headache
Nummular headache
Hypnic headache
New daily persistent headache

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16
Q

Primary cough headache

A

valsava

heavy lifting

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17
Q

Primary exercise headache

A

riding a bike during that period

18
Q

Primary headache associated with sexual activity

A

not that uncommon

19
Q

Primary thunderclap headache

A

having more than one

similar to cough but w/o the stimulus

20
Q

External-pressure headache

A

no clue what causes it

21
Q

Primary stabbing headache

A

brief sharp stabs

22
Q

Nummular headache

A

up to 6cm coin on the side of the head - could find edges of nummular

23
Q

hypnic headache

A

hypnosis - wakes you up from sleep

24
Q

New daily persistent headache

A

lasts at least 3 months

starts one day and becomes constant within 24 hours

25
Q

Common Secondary Headache Disorders

A

Intracranial hypertension

Intracranial hypotension

Occipital neuralgia

Trigeminal neuralgia

Medication overuse headache

Cervicogenic headache

26
Q

Opening Pressure

A

have the person lay on side so the pressure is not off to begin with

27
Q

Intracranial Hypertension

A

sheath protecting nerve
CSF around nerve

high pressure = CSF continuous with pressure behind eye - instead of being flat like it should be = it bulges out

28
Q

Glaucoma

A

yellow circle = optic nerve

cup to disc ration

pressure in eye is high = cup is expanded

29
Q

Intracranial Hypotension

A

low CSF pressure

key distinguish = position

pressure is worse with standing = upright

don’t know which structures are invloved
- some between bran and dura being stretched

30
Q

Intracranial Hypertension - sensory distribution of greater and lesser occipital n.

A

greater: not that common but misdiagnosed regularly

lesser: compression is unilateral
> nerve extends pass the distribution of nerve
> it is going to the eye = not a neuralgia

31
Q

Medication Overuse Headache

A

acetaminophen
barbiturate compounds
opiates

32
Q

Common Secondary Headache Disorders
Description:

A

Headache caused by a disorder of the cervical spine and its component bony, disc and/or soft tissue elements, usually but not invariably accompanied by neck pain.

33
Q

Diagnostic criteria:

A

A. Any headache fulfilling criterion C

B. Clinical and/or imaging evidence of a disorder or lesion within the cervical spine or soft tissues of the neck, known to be able to cause headache

C. Evidence of causation demonstrated by at least two of the following:

D. Not better accounted for by another ICHD-3 diagnosis.

34
Q

C. Evidence of causation demonstrated by at least two of the following:

A
  1. headache has developed in temporal relation to the onset of the cervical disorder or appearance of the lesion
  2. headache has significantly improved or resolved in parallel with improvement in or resolution of the cervical disorder or lesion
  3. cervical range of motion is reduced and headache is made significantly worse by provocative maneuvers
  4. headache is abolished following diagnostic blockade of a cervical structure or its nerve supply
35
Q

Cervicogenic Headache

A

unilateral pain that starts in the neck and is referred from bony structures or soft tissues of the neck

atlanto-occipital joint: O-C1

lateral atlant-axial joint: C1-2

C2-3: zygapophyseal joint and IVD

36
Q

“SNOOP” Mnemonic

A

Systemic symptoms (fever, weight loss, myalgias)

Secondary risk factors (immune deficiency, cancer, pregnancy)

Neurologic signs (papilledema, focal deficit, confusion, seizures)

Onset (sudden/thunderclap)

Older (new or progressive headache, especially over 50 years)

Pattern change (new symptoms in previously stable pattern)

Precipitants (Valsalva, position change, sexual activity)

37
Q

Scenario 1: 21 y/o female seeing you after ACL injury reporting headaches with visual disturbances.

A

refer to PCP

prob not cervogenic

migraine or aura

38
Q

Scenario 2: 64 y/o male seeing you for neck pain radiating to the head, worsened over the last few years, with moderate to severe arthritis on xray.

A

treat

this age group has more degenerative changes in the neck

arthritis developed over time

39
Q

Scenario 3: 40 y/o female seeing you for back pain after a recent motor vehicle accident who appears confused and a little unsteady on her feet.

A

refer to ER

ask Q’s first

SNOOP and red flags

40
Q

Scenario 4: 60 y/o female with history of migraine who reports a significant change in her headaches recently.

A

refer to neurology or PCP

SNOOP - change in previously stable

MSK II FINAL (13 decks)

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