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Clin med exam 2 > Headaches > Flashcards

Headaches Flashcards

1
Q

Acute

A

now, 1-2 days

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2
Q

Subacute

A

recent, 2d- 2w

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3
Q

Chronic

A

months- years

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4
Q

Remote

A

long time

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5
Q

Most common type of headache

A

migraine

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6
Q

Prodrome of migraine

A

hours-days

irritability 
depression 
yawning 
increased need to urinate
food cravings 
sensitivity to light/sound 
problems concentrating 
fatigue and muscle stiffness 
difficulty speaking and reading 
difficulty sleeping
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7
Q

Aura of migraine

A

5-60 min

visual disturbances
temporary loss of sight
numbness and tingling

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8
Q

headache of migraine

A

4- 72 hours

throbbing 
drilling 
icepick in head 
burning 
n/v
giddiness 
insomnia 
nasal congestion 
anxiety 
depressing mood 
sensitivity to light, smell and sound 
neck pain and stiffness
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9
Q

Postdrome of migraine

A

24-48 hrs

inability to concentrate 
fatigue 
depressing mood 
euphoric mood 
lack of comprehension
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10
Q

Atypical migraine is ___

A

migraine with different characteristics

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11
Q

Cause of migraine?

A

calcitonin gene related protein signaling is thought to be exaggerated in migraine people

calcitonin is a neuropeptide that signals pain in the trigeminal nerve

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12
Q

Drug approach to treat migraines

A

blocking calcitonin gene related peptide receptors

migraine meds block calcitonin GRP receptors (not vasoconstrictors)

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13
Q

Rescue medications for migraines (stop headaches)

A
  1. OTC
    ibuprofen (kidneys and stomach) and tylenol (liver)
  2. Triptans (serotonin R ant) ex. Imitrex
    = vasoconstrictor
    - avoid in MI/stroke
    - causes paresthesia
  3. Ergot (serotonin R ant)
    = vasoconstrictor
    - causes nausea, give anti-emetics
  4. Pain killer ex. butalbital
    - has coffee and tylenol
    - relaxes muscles- sedation
    - alt. for pts with strokes

MAKE SURE ITS ANT AND NOT AGON

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14
Q

Headache cocktail

A

ER situations

  1. Ketorolac/toradol- ibuprofen type
  2. Benadryl- antihistamine
  3. Compazine- nausea med, dopamine receptor antagonist (like haldol) can cause tardive dyskinesia
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15
Q

What meds should you not give for migraines to people with hx of strokes or MI?

A

triptans or Ergots

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16
Q

Medication overuse headaches

A

taking too many migraine meds causes migraines

any med more than 2x/w –> headaches

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17
Q

Tx for medication overuse headaches

A

medrol dosepak = a steroid- help with inflammation, not good for people with diabetes

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18
Q

What gives you rebound headaches?

A

opiates

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19
Q

What is great to give pts that call the office with headaches?

A

Toradol/ketorolac and medrol dosepak

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20
Q

Migraine and neck pain?

A

muscle relaxers (tizanidine, flexeril), steroid injection

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21
Q

Migraine and weight loss

A

Topamax (antiseizure med) that causes weight loss

s/e: word finding

22
Q

Natural supplements for migraines

A

magnesium
coenzyme q10
riboflavin b2
vit d

23
Q

Location of headaches

A 
sinus 
cluster
neck 
tension 
migraine 
TMJ
24
Q

Tension headache

A

band like, mild, short

triggered by stress

25
Cluster headache
NS symptoms- rhinorrhea, lacrimation, miosis, ptosis unilateral headache orbital, supraorbital and temporal regions- around the eye vs migraine- one side of face/head
26
Cluster headache treatment
100% oxygen serotonin agonist ergotamine
27
idiopathic intracranial hypertension (pseudotumor cerebri) occurs in ____
obese patients pulsatile tinnitus headaches blurred vision get eyes checked-- pupils dilated
28
acute idiopathic intracranial hypertension tx
LP- until pressure back to normal LPs can cause headaches!= sitting up makes it worst
29
chronic idiopathic intracranial hypertension tx
diet and diamox = carboxylase inhibitor
30
Concussion can cause _____ tx?
headaches dizziness insomnia mood swings tx: medrol dosepak amitriptyline
31
Sleep apnea
can cause headaches
32
Occipital neuralgia
= inflamed neck nerves
33
Sinus headaches and tx
migraines in disguise tx: nasal corticosteroids antibiotics (augmentin) allergy testing
34
Temporomandibular joint disorder (TMJ) and tx
inflammation in the tmj tx: steroids ibuprofen
35
Trigeminal neuralgia
= horrible shooting pain | V1, 2, 3
36
Temple tenderness and over 50 ?
giant cell arteritis
37
Giant cell arteritis may go blind unless ?
started on steroids
38
Neuro exam for headaches
``` evaluate papilledema temple tenderness occipital notch tenderness tap on sinuses reflexes ```
39
Imagining for migraine is ___?
MRI without contrast worried about blood (first line)/trauma- epidural hematomas worried about brain tumors when new onset of migraines visual symptoms weird symptoms
40
Migraines can cause ___?
chronic small vessel disease
41
When should you worry with headaches?
sudden and new visual issues thunderclap headache
42
Order MRV (MRI venogram) when you have headaches with ____
seizures or risk for clots.... cerebral venous thrombosis
43
Order a CTA or MRA if you are worried about ___
aneurysms
44
Think ____ when you have headaches, fever, and confusion
encephalitis (brain infection)
45
Think ____ when you have headache, neck pain/stiffness, and fever
meningitis (inflammation of meninges- tissue layer surrounding brain and spinal cord)
46
Meningitis tx
blood cultures stat abx, antiviral, steroids head ct LP
47
Order a LP if CTA/MRA was negative but have classic symptoms for ____
aneurysm/subarachnoid hemmorage
48
___ are fairly benign tumors
Meningiomas
49
Most glioblastomas are ____
lethal
50
AV (arteriovenous) malformations are typically found _____
accidentally or after the bleed

Clin med exam 2 (12 decks)

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