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PAEP Neurology > Headaches > Flashcards

Headaches Flashcards

1
Q

def primary headache?

A

not caused by underlying condition ➔ tension, cluster, migraine

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2
Q

def secondary headache?

A

caused by underlying condition ➔ HTN, trauma, masses, infections, preeclampsia

rare but more serious

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3
Q

def cephalalgia

A

any type of pain affecting the head, face, or neck

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4
Q

what is the hypothesized theory for the patho of primary headaches?

A

sensitization of nociceptive neurons and long-lasting activation triggers a headache attack via local inflam marker releasing ➔ activate trigeminal nociceptors

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5
Q

what are common vascular etio for secondary headaches?

A
  • hemorrhage ➔ thunderclap headache
  • giant cell arteritis
  • carotid artery dissection
  • acute angle-closure glaucoma ➔ thunderclap
  • HTN emergency ➔ thunderclap
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6
Q

what are common infectious etio for secondary headaches?

A
  • meningitis
  • encephalitis
  • sinus infections
  • carbon monoxide poisoning
  • toxin exposure or withdrawal
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7
Q

what are common neoplastic etio for secondary headaches?

A
  • mass lesions (tumours, abscesses, cysts)
  • acute hydrocephalus
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8
Q

what are common traumatic etio for secondary headaches?

A
  • back of head ➔ direct or indirect stuctural lesions
  • contusions
  • skull fractures
  • edema of brain
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9
Q

at what age is it most common to get headaches?

A

peaks around 25-40Y
more common in females than males

it is NOT normal for headaches to occur in >50Y

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10
Q

T/F: the brain has nociceptors

A

nociceptors: pain receptors
False
headaches are a result of pain from surrounding structures ➔ from stretching, dilatation, constriction, or any nociceptor stimulation

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11
Q

general characteristics for migraine

A

POUND mnemonic (>= 4)
- Pulsatile quality/throbbing
- hOurs - 4-72h duration
- Unilateral location
- Nausea or vomiting
- Disabling intensity

gradual onset - may have an aura (visual disturbances - positive neuro symptom)
worse at night
associated with N/V, photo or phono phobia

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12
Q

triggers for migraine

A

emotional stress, hormone changes (menses or OCP), exercise, irregular sleep/eating, schedule changes, increase caffeine/EtOh

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13
Q

tx for migraines

A

lifestyle: avoid triggers/stress, better sleep/hygiene/hydration, vitamin supplementation (B2 and magnesium)

acute/abortive:
- first line: NSAIDs and acetaminophen
- consider acute migraine cocktail in ED: ketorolac, metoclopramide, dexamethasone, and fluids
- second line: triptans > ergot alkaloids
- new classes: gepants

preventative:
- TCA, BB, CCB, anticonvulsants

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14
Q

what complication are we worried about in migraine pts?

A

medication overuse headaches
- esp with NSAID/acetaminophen and triptan use

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15
Q

characteristics of tension headache

A

MC headache
- episodic, band-like non-severe pain
- tightness around forehead
- not aggrevated by physical activity
- responds well to pain meds
- no migraine systemic features

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16
Q

how to tx tension headaches?

A

NSAIDs and acetaminophen

17
Q

characteristics of cluster headache

A

brief episodes of unilateral deep and excruciating pain around the eye or temple w/ s/s/ involving the trigeminal nerve

trigeminal nerve s/s: runny nose, Horner’s syndrome (ptosis, constricted pupil, facial anhidrosis), sweating, and pallow

18
Q

tx of cluster headache

A

acute: 100% O2 and triptans
Prophylactic: verapamil, lithium, and valproic acid

19
Q

RF for headaches

A

comorbidtiies: HTN, HIV, other immunosuppressive conditions

drug use: cocaine, meth, ASA, NSAIDs, anticoags, glucocorticoids

20
Q

headaches in those >50Y are most likely dt _______ causes

A

secondary

21
Q

red flags for headache

A

SNOOP4

S - systemic symptoms: fever, night sweats, wt loss
N - neurologic symptoms: AMS, seizures, visual disturbances
O - onset >50Y
O - onset sudden and severe
P - pattern change or progression
P - precipitated by valsalva
P - positional aggravation
P - papilledema

22
Q

what are the Canadian CT head rules? def

A

to determine when a CT head is indicated for minor head injuries

23
Q

criteria for the Canadian CT head rules?

A
  • GCS <15 at 3h after injury
  • sus open or depressed skull fracture
  • any sign of basal skull fracture ➔ hemotympanum, raccoon eyes, CSF otorrhea/rhinorrhea (halo sign), and battle’s sign
  • vomitting >= 2 episodes
  • age >65Y
  • amnesia before impact >30min
  • dangerous mechanism
24
Q

what key ix should we consider when working up red flag esque headaches?

A
  • CT head or CTA ➔ thunderclap
  • LP for CSF analysis ➔ meningitis
  • preg test ➔ preeclampsia
  • sugar
  • carboxyhemoglobin ➔ r/o carbon monoxide poisoning
  • ESR/CRP ➔ GCA
25
Q

when can we NOT use the Canadian head CT rules?

A
  • pt is on warfarin
  • has a bleeding disorder
  • had a seizure before ED arrival
  • <16Y
  • no traumatic brain injury

PAEP Neurology (18 decks)

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