Headaches

Question 1

Remember to review all the serious types of headaches - too many to do cards for them all.

Answer 1

look at notes

Question 2

Intracranial Hypertension causing headaches

Answer 2

idiopathic headaches due to increased ICP - usually presents with papilledema in young, overweight women with polycystic ovarian disease.

Question 3

Giant cell arteritis (temporal arteritis)

Answer 3

systemic vasculitis w/ affinity for cranial vessels - can lead to stroke. Steroids can reverse the disease.

Question 4

What are the exclusion criteria for a dangerous headache?

Answer 4

1. no hx of serious headache or neck injury, seizures or focal neuro symptoms or infections
2. pt afebrile
3. diastolic BP <120
4. normal fundi
5. supple neck
6. no cranial bruits
7. normal neuro exam and LOC
8. normal CBC, ESR, cranial imaging, x-rays

Question 5

Migraine

Answer 5

episodic, severe, unilateral, throbbing headaches that may present with exercise intolerance, anorexia, N/V, photophobia, &/or phonophobia. Lasts hrs-days. Usually presents in childhood or adolescence.

Question 6

Migraine Aura

Answer 6

present with some migraines, the aura presents with a visual, somatosensory, olfactory or language changes with positive and negative symptoms that slowly comes on over 10-60 mins.

Question 7

Familial hemiplegic migraine

Answer 7

migraines characterized by early onset and family history. There are 3 known mutations, and it is thought that these people have a lower threshold for cortical spreading depression.

Question 8

Tx for migraine

Answer 8

avoid triggers
medications during the headache
prophylactic meds

Question 9

What meds are available for acute relief of migraines?

Answer 9

1. analgesics
2. antiinflammatory meds
3. activators of serotonin receptors - Ergotamine & Triptans (decrease CGRP and substance P release)

Question 10

What meds are available for prophylaxis in migraine tx?

Answer 10

1. beta-blockers
2. Ca channel blockers
3. heterocyclic antidepressants
4. anticonvulsants
5. Botox

Question 11

Cluster HA

Answer 11

uncommon, but very severe HA that presents with unilateral orbital, supraorbital and/or temporal pain lasting 15 mins-3hrs. Often associated with other findings on same side of face (ptosis, lacrimation, miosis, nasal congestions, eyelid edema, conjunctival injection)

Question 12

Tension Type HA

Answer 12

HA presenting with mild cervical or bifrontal pain when person is stressed. It is due to increased muscle activity. Muscles relaxants often relieve the headache. high risk for analgesic rebound HA

Question 13

Medication Overuse Headache

Answer 13

HA occurring on > 15 days/mo in a pt with a pre-existing HA disorder w/ regular overuse of meds for > 3 mo. HA return to usual within 2 mo once meds are stopped.

Question 14

What 4 things can “dizzy” mean?

Answer 14

1. vertigo
2. presyncope
3. disequilibrium
4. other (floating type of sensation or something else)

Question 15

peripheral vertigo

Answer 15

damage to the inner ear or vestibulocochlear nerve that often produces abnormal eye movements (nystagmus), hearing loss or tinnitis, and nausea or motion sickness.

Question 16

central vertigo

Answer 16

damage to the brainstem (vestibular nuclei and vestibulocerebellum) that presents with dizziness or spinning and often produces a nystagmus that may be in multiple directions or vertical. Often presents with other central nervous system findings.

Question 17

Paroxysmal positional vertigo

Answer 17

peripheral vertigo provoked by movement. it is the most common type and generally considered benign. Seen after head trauma and in the elderly. Starts after bending over, looking up, or rolling over. Lasts 15-60 secs.

Question 18

Cervicogenic vertigo

Answer 18

peripheral vertigo caused by movement or sustained neck positions - it usually lasts while the position is maintained.

Question 19

Meniere Syndrome

Answer 19

peripheral vertigo provoked by noise. This is caused by increased pressure in the endolymph. can last 30 mins - few hrs. Overtime may cause tinnitus.

Question 20

Perilymph fistula

Answer 20

peripheral vertigo provoked by noise (changes in pressure) that is due to a leak between the inner and middle ear.

Question 21

Chiari malformation

Answer 21

cause of central vertigo where the lower portion of the cerebellum protrudes through the foramen magnum and compressed the caudal brainstem.

Question 22

Causes of central vertigo

Answer 22

1. cerebrovascular disease (TIA)
2. multiple sclerosis
3. Chiari malformation
4. migraine
5. damage to the caudal brainstem or vestibulocerebellum

Question 23

Presyncope

Answer 23

results from diffuse cortical ischemia - cardiac causes are the most worrisome, though vaso-vagal events are the most common cause

Question 24

Disequilibrium

Answer 24

Caused by disturbance of sensory and motor systems for upright posture. Usually it is the result of a multisensory deficit (inner ear, eyes, and feet proprioceptors keep you standing).

Question 25

What is the difference between episodic and chronic migraines?

Answer 25

Episodic < 15d/mo

Chronic > 15d/mo