Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neurology > Headaches > Flashcards

Headaches Flashcards

1
Q

Migraine Pathophysiology (7)

A
  • Not well understood
  • Related to neurovascular dysfunction
  • Dilation of bv’s innervated by CN5
  • Change in brainstem sensory nuclei
  • Initially: cerebral blood flow decreases
  • Later: cerebral blood flow increases, hyperemia
  • Cortical spreading depression of leao (starts in occipital region and spreads forward)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Migraine Clinical Presentation

A
  • Lateralized, throbbing headache
  • Onset: adolescents, early adulthood
  • Gradual onset with aura
  • Visual field defects
  • Scintillating scotoma (flashing lights)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Migraine S/S (14)

A
  • Anorexia
  • N/V
  • Photobia
  • Phonophobia
  • osmophobia
  • cognitive impairement
  • blurred vision
  • aphasia
  • numbness
  • paresthesia
  • clumsiness
  • dysarthria
  • dysequilibrium
  • weakness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some triggers for migraines? (7)

A
  • Stress
  • sleep disturbance
  • missed meals or specific foods
  • alcohol
  • bright lights
  • loud noise
  • menstruation or OC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Atypical Migraines (3)

A
  • Basilar artery migraine
  • opthalmoplegic migraine
  • Familial hemiplegic migraine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Basilar Artery Migraine (4)

A
  • Blindness or bilateral visual disturbances
  • accompanied by dysarthria, dysequilibrium, tinnitus, perioral or distal paresthias
  • Loss of consciousness or confused state sometimes
  • followed by a throbbing occipital headache and N/V
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Opthalmoplegic Migraine (5)

A
  • Lateralized pain around eye
  • Accompanied by N/V and diplopia
  • Diplopia may outlast headache for days
  • CN5 opthalmic division may be involved
  • Rare
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Familial Hemiplegic Migraine (2)

A
  • Autosomal Dominant

- Attacks of lateralized weakness on one side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Overview of Tx for Migraines (3)

A
  • avoidance of precipitating factor
  • symptomatic tx
  • prophylactic pharmacologics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Symptomatic Tx of Migraines (7)

A
  • Rest, quiet dark room
  • OTC analgesics
  • Cafergot
  • Antiemetics
  • Sumatriptan/ Zolmatriptan
  • Opioids
  • propofol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Preventative Tx of Migraines

A
  • If headaches occur more than 2-3x per month
  • If headaches are very severe
  • Try in succession
  • Continue for several months then slowly taper
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Prophylactic Drugs for Migraines

A
  • Topiramate
  • Valporic acid
  • candesartan
  • propanolol
  • timolol
  • verapamil
  • amitriptyline
  • Botulinum toxin A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Cluster Headaches (5)

A
  • M>F 10:1
  • No FmHx
  • Episodic, severe retro-orbital or periorbital pain or Horner’s syndrome
  • Occur daily for several weeks and then remit
  • Pts are restless and agitated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Cluster Headache Clinical Presentation (7)

A
  • Unilateral nasal congestion (may happen)
  • lacrimation (may happen)
  • rhinorrhea (may happen)
  • redness of the eye (may happen)
  • Often occur at night, waking the pt
  • Last 30mins-3hrs
  • Last 4-8 wks and recur 3-4x per yr
  • EtOH, certain foods, bright lights, stress are all triggers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Symptomatic Tx for Cluster Headaches (6)

A
  • oral drugs don’t really work
  • SQ or intranasal sumatriptan
  • intranasal zolmatriptan
  • O2 NRB mask high flow (12-15L)x15mins
  • Dihydroergotamine
  • Viscous lidocaine intranasal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Prophylaxis Tx of Cluster Headaches (8)

A
  • Lithium
  • Verapamil
  • Topiramate
  • Valproate
  • Suboccipital corticosteroid injection
  • ergotamine
  • prednisone
  • occipital nerve stimulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Hemicrania Continua (3)

A
  • Unilateral head pain a/w autonomic symptoms
  • Not episodic
  • Completely treated with indomethacin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the most common type of headache?

A

Tension Headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Tension Headache Clinical Presentation (7)

A
  • pericranial tenderness
  • Occiptal region radiating to the forehead
  • “vise like” not pulsatile
  • daily
  • poor concentration
  • No focal neurological symptoms
  • Exacerbated by: emotional stress, fatigue, noise, bright light
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Tx of Tension Headaches (6)

A
  • Similar to migraine
  • Triptans don’t help
  • Tx associated anxiety or depression
  • massage
  • hot baths
  • biofeedback
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Depression Headache (4)

A
  • Worse when you wake up in am
  • A/w other symptoms of depression
  • antidepressant drugs
  • psychiatric consultation
22
Q

Posttraumatic Headaches

A
  • Follow a closed head injury
  • independent of loss of consciousness
  • Variety of non-specific symptoms
  • Common
  • Appear within a day or two of injury
  • Worsens then subsides over weeks
  • Constant dull ache with throbbing
  • May be localized
23
Q

Posttraumatic Headache Clinical Presentation (8)

A
  • N/V
  • Scintillating scotomas (flashing lights)
  • If they start 2 weeks after injury, may be something else
  • dysequilibrium enhanced by movement
  • impaired memory
  • poor concentration
  • emotional instability
  • increased irritability
24
Q

Post Traumatic Headache Tx (8)

A
  • CT/MRI to r/o focal symptoms
  • encouragement
  • NSAIDs
  • Tylenol
  • Amitriptyline
  • Propanolol
  • ergotamines
  • antiseizure meds
25
Q

Cough Headache

A
  • Last several minutes
  • 10% have chiari malformations (part of cerebellum through the foramen magnum)
  • Brain tumors may present this way
  • CT/MRI is indicated
  • Should repeat imaging for 3 yrs to r/o lesion
26
Q

Cough Headache Tx

A
  • Self limited, may last several years
  • May be relieved by LP (decrease ICP)
  • Indomethacin
27
Q

What arteries are affected by Temporal Arteritis?

A

Arteries affected:

  • temporal
  • vertebral
  • opthalmic
  • posterior ciliary
28
Q

Temporal Arteritis (7)

A
  • Affects elderly
  • Headache= major symptom
    May be a/w:
  • myalgia
  • malaise
  • anorexia
  • wt loss
  • non-specific complaints
29
Q

Temporal Arteritis PE (4)

A
  • Scalp tenderness over temporal arteries
  • Jaw claudication
  • Increased sed rate
  • Can cause monocular blindness if untreated
30
Q

Temporal Arteritis Tx (2)

A
  • Prednisone

- Biopsy promptly

31
Q

Intracranial Mass Lesions (6)

A
  • Displacement of vasculature/tissue causes headaches
  • Headaches range from mild to severe
  • Non-specific
  • Worsened with exertion or postural change
  • N/V
  • Progressive headaches/ new onset in adulthood merits further imagining, not normal
32
Q

Medication Overuse Headache (4)

A
  • Responsible for half of daily chronic headaches
  • Severe headache unresponsive to meds
  • Hx of pain meds
  • Start a migraine prevention regimen
33
Q

Pseudotumor Cerebri (3)

A
  • AKA benign intracranial HTN
  • Headache is worse on straining
  • visual disturbances are common d/t papilledema and Abducens nerve palsy (diplopia)
34
Q

Pseudotumor Cerebri Causes (6)

A 
- Thrombosis of the transverse sinus d/t sinusitis or mastoiditis
– Thrombosis of the sagittal sinus
– Chronic pulmonary disease
– Endocrine disturbances 
- (Hypoparathyroidism)
- (Addison’s disease)
– Vitamin A toxicity
– Tetracycline or OCs
35
Q

Pseudotumor Cerebri Diagnosis (5)

A
  • CT/MRI should be done to r/o mass lesions
  • Small or normal ventricles may be seen
  • MR venography:
    – thrombosis of the intracranial venous sinuses
    – LP confirms intracranial hypertension, CSF is normal
36
Q

Pseudotumor Cerebri Tx (6)

A

– Untreated, PC will cause optic atrophy and blindness
– Acetazolamide – reduces CSF formation
– Prednisone may also be helpful
– Obese patients should be counseled to lose wt
– Repeat LP to lower ICP
– Medical treatment is mainstay – monitored by checking fundoscopic exam, visual fields and acuity and CSF pressure

37
Q

What do you do if you cannot treat pseudo tumor cerebra?

A

If unresponsive to medical therapy, surgical lumboperitoneal shunt can be done or fenestration of the optic nerve sheath to preserve vision

38
Q

Trigeminal Neuralgia (4)

A
  • AKA Tic Doloureux
  • Common in mid and later life
  • F>M
  • Facial Pain
39
Q

Trigeminal Neuralgia Clinical Presentation (7)

A
  • Stabbing pain on one side of the face
  • Distribution of 2nd & 3rd branches of CN5
  • Brief episodes of pain
  • Exacerbated by touch, cold, moving, chewing
  • Starts near mouth, radiates to ear, eye, nose
  • Episodes become more frequent
  • Dull ache may persist between episodes
40
Q

Trigeminal Neuralgia PE

A
  • Negative neurological exam
  • CT/MRI normal
  • If the patient is young, suspect MS
  • Check CSF and evoked potentials
41
Q

Trigeminal Neuralgia Pharmacological Tx

A
  • Oxacarbazepine or carbamazepine
  • Phenytoin
    – Baclofen
    – Lamotrigine
    – Gabapentin
42
Q

Trigeminal Neuralgia Ablative Tx

A

– Posterior fossa exploration to decompress the nerve (not in MS)
– Radiofrequency rhizotomy can be used in elderly patients
– Gamma knife on the root

43
Q

Atypical Facial Pain

A
  • Burning, constant pain, starts as localized but spreads
  • May cross the midline, go to neck or posterior scalp
  • Common in middle-aged women
  • Associated with depression
44
Q

Atypical Facial Pain Tx

A
  • Treat with analgesics and TCA, carbamazepine, oxcarbazapine, phenytoin
  • NO SURGERY
45
Q

Glossopharyngeal Neuralgia (5)

A
  • Similar to trigeminal neuralgia but affects the throat
  • Peri-tonsillar or posterior tongue pain
  • Pain may be precipitated by swallowing, chewing, yawning, talking
  • Sometimes accompanied by syncope
  • Rule out MS
46
Q

Glossopharyngeal Neuralgia Tx

A
  • Rule out MS
  • Treat with carbamazepine, oxcarbazapine first
  • Consider surgical exploration with decompression second
  • Ablation is generally not used
47
Q

Postherpetic Neuralgia

A 
- Develops in 15% of ppl who had shingles
Most likely in:
- elderly
- immunocompromised
- severe rash
- 1st division of CN5 is affected
48
Q

Postherpetic Neuralgia Tx (4)

A

– Simple analgesics
– TCA
– Carbamazepine, phenytoin, gabapentin, pregabalin
– Topical capsaicin cream or lidocaine

49
Q

What are other causes of facial pain? (7)

A
  • TMJ dysfunction
  • Giant cell arteritis (masticatory claudication)
  • Dental pain
  • Sinusitis
  • Ear infections
  • Glaucoma
  • Pain in the jaw may be angina
50
Q

When should you refer a facial pain pt?

A
  • Acute onset of “the worst headache in my life”
  • Increasing headache unresponsive to simple measures
  • History of trauma, hypertension, visual changes, fever
  • Presence of neurologic signs or scalp tenderness

Neurology (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions