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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
Q

Cluster headache

A

NS symptoms- rhinorrhea, lacrimation, miosis, ptosis

unilateral headache
orbital, supraorbital and temporal regions- around the eye

vs migraine- one side of face/head

26
Q

Cluster headache treatment

A

100% oxygen
serotonin agonist
ergotamine

27
Q

idiopathic intracranial hypertension (pseudotumor cerebri) occurs in ____

A

obese patients

pulsatile tinnitus
headaches
blurred vision

get eyes checked– pupils dilated

28
Q

acute idiopathic intracranial hypertension tx

A

LP- until pressure back to normal

LPs can cause headaches!= sitting up makes it worst

29
Q

chronic idiopathic intracranial hypertension tx

A

diet and diamox = carboxylase inhibitor

30
Q

Concussion can cause _____

tx?

A

headaches
dizziness
insomnia
mood swings

tx:
medrol dosepak
amitriptyline

31
Q

Sleep apnea

A

can cause headaches

32
Q

Occipital neuralgia

A

= inflamed neck nerves

33
Q

Sinus headaches and tx

A

migraines in disguise

tx:
nasal corticosteroids
antibiotics (augmentin)
allergy testing

34
Q

Temporomandibular joint disorder (TMJ) and tx

A

inflammation in the tmj

tx:
steroids
ibuprofen

35
Q

Trigeminal neuralgia

A

= horrible shooting pain

V1, 2, 3

36
Q

Temple tenderness and over 50 ?

A

giant cell arteritis

37
Q

Giant cell arteritis may go blind unless ?

A

started on steroids

38
Q

Neuro exam for headaches

A 
evaluate papilledema 
temple tenderness 
occipital notch tenderness 
tap on sinuses 
reflexes
39
Q

Imagining for migraine is ___?

A

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
Q

Migraines can cause ___?

A

chronic small vessel disease

41
Q

When should you worry with headaches?

A

sudden and new visual issues

thunderclap headache

42
Q

Order MRV (MRI venogram) when you have headaches with ____

A

seizures or risk for clots…. cerebral venous thrombosis

43
Q

Order a CTA or MRA if you are worried about ___

A

aneurysms

44
Q

Think ____ when you have headaches, fever, and confusion

A

encephalitis (brain infection)

45
Q

Think ____ when you have headache, neck pain/stiffness, and fever

A

meningitis (inflammation of meninges- tissue layer surrounding brain and spinal cord)

46
Q

Meningitis tx

A

blood cultures stat
abx, antiviral, steroids
head ct
LP

47
Q

Order a LP if CTA/MRA was negative but have classic symptoms for ____

A

aneurysm/subarachnoid hemmorage

48
Q

___ are fairly benign tumors

A

Meningiomas

49
Q

Most glioblastomas are ____

A

lethal

50
Q

AV (arteriovenous) malformations are typically found _____

A

accidentally or after the bleed

Clin med exam 2 (12 decks)

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