Headaches Flashcards
First step in idiopathic intracranial hypertension (pseudotumor cerebri):
LP: document an opening pressure, which will be elevated. It will also temporarily relieve symptoms.
What is Acetazolamide and how is it used?
A carbonic anhydrase inhibitor, used to decrease CSF production in idiopathic ICH patients.
Excess intake of which vitamin has been shown to lead to pseudotumor cerebri?
Vitamin A
Idiopathic ICH presentation:
Young, obese females, due to impaired absorption of CSF. Headache, transient episodes of visual loss due to increased pressures (sneezing/coughing). Papilledema.
MRI findings of idiopathic ICH:
“Slit-like” ventricles; empty sella (flattening of the pituitary due to pressure).
Initial treatment for temporal arteritis:
Prednsone
Most feared complication of untreated temporal arteritis is:
Unilateral vision loss
What is temporal arteritis?
Arteritis of extracranial carotid artery and its branches, patients >60 with indolent headache in the temple, jaw claudication (pain with chewing), associated with PMR. Elevated ESR/CRP, biopsy.
Treatment for cluster headaches:
100% oxygen
Criteria for a cluster headache:
At least 5 attacks of severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 min untreated, with 1+ signs on same side:
- Conjunctival injection
- Lacrimation
- Nasal congestion
- Rhinorrhoea
- Forehead and facial sweating
- Miosis
- Ptosis
- Eyelid Edema
T/F: Migraine HA pain is bilateral.
False
A migraine without an aura is called a _____. A migraine with an aura is a _____.
common migraine; classic migraine
What is an ophthalmoplegic migraine?
Associated with retroorbital pain and cranial nerve palsies (3, 4, 6).
Which medication is indicated as an abortive treatment in migraines?
Sumatriptan
In which patients are triptans contraindicated and why?
CAD - they are vasoconstrictive, concern for stroke.
When is prophylactic migraine treatment indicated?
> 2/month, or when causing disruptions to the person’s lifestyle by missing school or work. Topiramate is the most commonly used medication, SSRIs are not acceptable.
What are headache red flags?
HA in older person with no history, HA associated with focal neuro deficits/personality changes, HA in immunocompromised, HA worse in the morning, HA associated with signs of systemic disease (fever, weight loss, etc.).
A glioma is a tumor that arises from the glial cells of the brain, what are they?
Astrocytes, oligodendrocytes, ependymal cells, and choroid plexus cells.
Most common tumor of childhood:
Medulloblastoma. Occur in the cerebellum and present with ataxia as well as signs of increased ICP (headaches, vomiting).
Cerebellar masses in adults are what?
Mets
Non glial tumors include:
Meningiomas and Primary CNS lymphomas.
Where is it thought that meningiomas arise?
The arachnoid
Multiple meningiomas can occur as a feature of what?
NF2
Most common source of mets overall:
Lung tumors
Which tumors are well known to bleed?
Melanomas, renal cell cancers, choriocarcinomas.
Where are most mets found in the brain and why?
Junction of gray/white matter, they spread hematogenously.
Enhancement of the meninges on imaging is:
intracranial hypOtension
Tumors that can grow in the ventricles (and how they present):
Colloid cyst, meningioma, central neurocytoma: they can block the flow of CSF and cause positional HA and LOC due to sudden increases in ICP with acute obstruction.
Characteristics of closed-angle glaucoma:
More common in asian countries, sudden ocular pain, halos around lights, red eye, very high intraocular pressure, n/v, decreased vision, and a fixed, mid-dilated pupil. This is an emergency needing timolol drops to the eyes.
