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Medicine II: Neurology > Headaches > Flashcards

Headaches Flashcards

1
Q

What are the red flags for headaches?

A

“new” or “worst” headache
thunderclap, increasing frequency or intensity
known or suspected medical condition
immune compromise
prior history of malignancy
morning or cough head ache (traction symptoms: head turning, sneezing, coughing, valsalva)
age >50
meningismus
localized neurological findings (meningismus, papilledema, focal deficits, vision loss, jaw claudication)

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2
Q

Meningitis (infection headache):

A

acute onset
severe, constant
photophobia, phonophobia, siezure

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3
Q

PE of meningitis:

A

fever

meningismus (kernig, brudzinski), altered mental status

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4
Q

Labs for meningitis:

A

leukocytosis

LP

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5
Q

Imagine for meningitis:

A

normal

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6
Q

Causes of meningitis headaches:

A

viral, bacterial, fungal

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7
Q

Tx for meningitis headaches:

A

3rd gen cephalosporins, and treat underlying cause

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8
Q

Intracerebral Hemorrhage:

A

acute onset
variable
n/v

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9
Q

PE for intracerebral hemorrhage:

A

HTN
focal deficit
lethargy
meningismus

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10
Q

What are the most common locations for HTN hemorrhages?

A

pons, thalmus, putamen, and cerebellum

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11
Q

What do we suspect if the hemorrhage occurred on or near the cortex?

A

amyloid angiopathy

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12
Q

Tx for intracerebral hemorrhage:

A

correct coagulopathy
control BP
may need to evacuate the hemorrhage

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13
Q

Subarachnoid Hemorrhage:

A

acute onset
severe photophobia, phonophobia, n/v
SENTINEL BLEED

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14
Q

PE of SAH:

A

meningismus
altered mental status
possibly cranial nerve abnormalities

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15
Q

Imaging for SAH:

A

blood with sulci and/or ventricles

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16
Q

Diagnosis of a SAH:

A

LP:
cell count should show elevated RBC
xanthochromia (yellowish color of CSF)

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17
Q

What causes a SAH:

A

aneurysmal rupture
arterio-venous malformation
trauma
coagulopathy

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18
Q

What is a complication seen in SAH?

A

vasospasms- an abnormal, severe constriction of blood vessels as a result of the irritating effects of subarachnoid blood

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19
Q

Tx of a SAH:

A

TRIPLE H: HTN, hypervolemia, hemodilution

Ca+ channel blocker (nimodipine)

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20
Q

Temporal Arteritis:

A 
>50
jaw claudication
vision loss
fever
weight loss
Polymyalgia Rh??
giant cell arteritis
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21
Q

PE of Temporal arteritis:

A

vision loss

temporal tenderness

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22
Q

DX of Temporal arteritis:

A

ESR>80

Temporal artery biopsy

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23
Q

Tx for Temporal arteritis:

A

steriods (prednisone/methylprednisone)- presumptive therapy

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24
Q

What is a complication of temporal arteritits?

A

permanent blindness

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25
Q

What is the most common neurological condition a/w headaches?

A

migraine

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26
Q

Migraine Dx:

A 
gradual build up
4-72 hr headache
visual aura (scotoma, flashing lights)
unilateral localization
pulsating
moderate to sever intensity
aggravated by routine activity
n/v
photophobia and phonophobia
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27
Q

What are common triggers of a migraine?

A 
sleep
stress
undernourished
menstrual period
exertion
changes in weather, altitude, traveling
lights and odors
alcohol
dietary
28
Q

T/F: migraine is under-diagnosed.

A

True

29
Q

How common is shoulder and neck pain with a migraine?

A

78%

30
Q

What are factors a/w migraine progression?

A

smoking
caffeine overuse
obesity
frequent use of abortive/analgesic meds

31
Q

Orthostatic headache:

A

pain starts with in a minute from rising
resolves promptly on laying down
seen often after an LP

32
Q

Tx for othostatic headache:

A

epidural injection of autologus blood patch

33
Q

Pseutdotumor/Itracranial HTN:

A

Daily headache for months
worsens when laying down, pulsatile
graying of vision
PAPILLEDEMA

34
Q

Tx of Pseutdotumor/Itracranial HTN:

A 
LP
Acetazolamide
weight loss
lumbar peritoneal shunt
optic nerve sheath fenestration
35
Q

Tx for dural sinus thrombosis:

A

heparin or coumadin

36
Q

Tx for a SAH:

A

embolization or clippin of aneurysm

37
Q

Tx for a intracerebral hemorrhage:

A

correct coagulopathy
permissive HTN
neurosurgical consolidation

38
Q

Pediatric migraine:

A 
recurrent belly pain
vomit once
pain goes away
episodic vertigo
motion sickness
icecream headache
39
Q

Tx of a pediatric migraine:

A

periactin
gabapentin
domperidone

40
Q

Cluster headache:

A 
middle aged men
severe unilateral periorbital pain
jack hammer headache
daily 90 min attacks of unilateral icepick pain w/ tearing and injection, a/w horners syndrome
early every morning
alcohol triggers the attacks
41
Q

Tx of a Cluster headache:

A

sumatriptan, 100% o2
verapamil
melatonin

42
Q

Hemicrania continua:

A

left sided headache
continuous aching pain, no pain-free periods
w/ brief 30 min spells of worsening
a/w gritty sensation in left eye and nasal congestion

43
Q

Tx of hemicrania continua:

A

indomethacin

44
Q

Hypnic Headache:

A

awakened every morning at 2am
30 min of aching throbbing frontal pain
then returns to sleep
sometimes reoccurs at 5am

45
Q

Tx of Hypnic Headache:

A

lithium carbonate

46
Q

What type of headache is the most common?

A

primary

47
Q

Tension Headache:

A 
pericranial tenderness
poor concentration
vise-like tight grip
not pulsatile
exacerbated by stress or glare
generalized( neck and shoulders)
48
Q

Tension headache tx:

A

rest in a quiet dark room, simple analgesic right away is effective

ergotamines (cafergot- contains caffeine)

49
Q

What is a cough induced headache a/w?

A

structural lesions of the posterior fossa

50
Q

When are tension headaches worst?

A

at the end of the day

51
Q

basilar artery migraine:

A

blindness/visual disturbance (bilateral)
tinnitus
impairment/loss of consciousness
followed by throbbing headache

52
Q

Migraine Tx:

A

rest in a quiet dark room, simple analgesic right away is effective

ergotamines (cafergot- contains caffeine)

triptans: sumatriptan (5-HT1 receptors)

53
Q

What is the most common type of primary headache disorder?

A

tension headaches

54
Q

post traumatic headache:

A

after trauma
dull ache with superimposed throbbing
n/v
scotomas

55
Q

Tx of post traumatic headache:

A

supportive

simple analgesic may be helpful

56
Q

Primary cough headache:

A

lasts only minutes

may clear after an LP

57
Q

T/F: in approximately half of all patients with chronic daily headaches, medication over use is responsible.

A

true

58
Q

What is the single most common chief complaint that brings a pt to medical care?

A

headache

59
Q

What is SNOOP4?

A 
red flags for headaches:
S- systemic symptoms
N- neurological symptoms
O- onset (sudden)
O- onset after 50
P - pattern change (progression, precipitated (cough), postural, papilledema)
60
Q

Who is more likely to get a migraine?

A

women, after puberty hits

61
Q

who is more likely to get a cluster headache?

A

men

62
Q

What is a characteristic of a person with a cluster headhache?

A

restless, hypothamlic involvement

63
Q

Who is most likely to get a tension headache?

A

women

64
Q

Trigeminal Neuralgia:

A 
not a headache disorder
episodic facial pain
severe
middle aged men
excruciating unilateral pain, shock-like
most common in 2nd max division
65
Q

What triggers trigeminal neuralgia?

A

shaving, applying make-up

jackhammer like pain

66
Q

PE for trigeminal neuralgia:

A

loss of corneal reflex
facial sensory loss
weakness in mastication muscles

67
Q

Tx for trigeminal neuralgia:

A

carbamazepine

Medicine II: Neurology (12 decks)

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