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Neurology II > Headache & Other Craniofacial Pain > Flashcards

Headache & Other Craniofacial Pain Flashcards

1
Q

What is the diff betw primary & secodnary headaches?

A

Primary = headache IS THE disorder/disease itself
Secondary = identified exogenous causes

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2
Q

What are the 3 most important types of headache?

A

Migraine
Tension-type headache = most common
Trigeminal autonomic cephalalgias (cluster headache)

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3
Q

What are the casues of 2ndary headaches?

A

Trauma/injury to the head & or neck
Cranial or cervical vascular disorder
Non-vascular intracranial disorder

Meningitis, subarachnoid hemorrhage, glaucoma, brain tumor, hypertension, etc

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4
Q

What awhat are the most common causes of primary & secondary headache?

A

Primary = tension type
Secondary = systemic infection

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5
Q

What re the pain-producing structures in the head?

A

Scalp
Meningeal arteries
Dural sinuses
Falx cerebri
Proximal segments of the large pial arteries

Brain parenchyma IS NOT PAIN-SENSITIVE

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6
Q

In general PE of headaches, what should u emphasize on?

A

Paransal sinus tenderness = t/c sinusitis

Palpation of the eys = t/c INC IOP

Neck rigidity = t/c meningitis & subarachnoid hemorrhage

Inspection & palpation of temporal arterities = t/c temporal enteritis

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7
Q

What condition is a recurring syndrome of headache assoc w/ OTHER SYMPTOMS OF neurological dysf w/ other admixtures?

A

Migraine

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8
Q

What are the 2 types of migraine?

A

Migraine with aura
Migraine without aura

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9
Q

What are the NT affected in migraine?

A

5HT (serotonin)
Dopamine

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10
Q

What are the diff attack phases of migraine?

A

Aura
Headache phase
Premonitory (prodromal)
Postdrome

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11
Q

What are s/sx of Prodromal phaes of migraine?

A

Neck discomfort
Yawning/sleepiness, polyuria/polydypsia, mood change, fatie, cognitive impairment

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12
Q

What are S/Sx of Aura phase of migraine?

A

Scintillating scotoma

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13
Q

What are s/sx of headache phase of migraine?

A

Pain
Nausea/vomiting
Sensory sensitivity

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14
Q

What are s/sx of postdrome phase of migraine?

A

Tiredness
Weakness
Concentration impairment

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15
Q

What are pharmacologic agents used for acute attacks of migraine?

A

Analgesics (Acetaminophen)
NSAIDs
Sumatriptan

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16
Q

What are prophylaxis for migraine?

A

Beta-blockers (propranolol)
Antidepressants (amitriptyline)
Anticonvulsants (topiramate, valproic acid)
Calcitonin gene-related protein

17
Q

What should be given as tx if a patient has 4 or more attacks per month or poor response to acute tx?

A

Propanolol and Flunarazine

18
Q

what are the most effective drug for acute migraine atatcks?

A

Triptans

19
Q

what are the s/sx of Tension-Type headache?

A

bilateral, tight, band-like
episodic or chronic (15 days or more in a month_
builds up slowly and fluctuates
“muscle contraction headache”

20
Q

what are tx of tension-type headache?

A

acetaminophen
NSAIDs
Amitriptyline = anti-depressant, for chronic types

21
Q

whatr are the diff types of trigeminal autonomic cephalalgias?

A

cluster headache
paroxysmal hemicrania
short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing

short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms

22
Q

what are cranial autonomic symptoms?

A

lacrimation
conjunctival injection
aural fullness
nasal congestion

23
Q

what are s/sx of cluster headache?

A

periodicity (<1 yr)
stabbing and excruciating pain
retro-orbital in location

24
Q

what causes cluster headache?

A

disorder of central pacemaker neurons
neurons in the posterior hypothalamus

25
Q

what are abortive tx for Cluster headache?

A

Sumatriptan injection/nasal spray
Oxygen
Zolmitriptan nasal spray

26
Q

what is a sign that headache is caused by subarachnoid hemorrhage?

A

anteflexion of the neck or
slightest nuchal catch

intraparenchymal bleeds will show focal signs

27
Q

what are signs that secondary headache is caused by meningitis?

A

fever
headache
neck rigiditiy

28
Q

what are signs that secondary headache is caused by epidural or subdural hematoma?

A

depressed sensorium outweighs focal deficits

29
Q

what are signs that secondary headache is caused by brain tumor?

A

chronic progressive headache that worsens over time

30
Q

what are signs that secondary headache is caused by purulent sinusitis?

A

sinus tenderness

31
Q

what type of craniofacial pain involves painful, lancinating, sudden pain in 1/2 of the face with excruciating pain in the lips, face, and gums?

A

Trigeminal neuralgia

32
Q

what are diff dx of Trigeminal neuralgia?

A

SUNCT and Trigeminal Autonomic cephalgia
Diseases of the jaw, teeth and sinuses
Temporal arteritis
Multiple Sclerosis
Compressive lesions of CN V

33
Q

What is the best tx given to px with Trigeminal neuralgia?

A

Carbamazepine or Tegretol

can also do:
Microvascular decompression (relieves pressure)
Gamma knife
Radiofrequency Thermal rhizotomy (comp: numbness)

Neurology II (7 decks)

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