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PCM > Headaches > Flashcards

Headaches Flashcards

1
Q

Types of headaches that are primary or benign

A

Tension
Cluster
Migraine

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2
Q

Secondary or malignant headaches

A

hangover (dehydration)
tumor
meningitis

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3
Q

Tension headaches- Dx

A 
Requires 2 or more of the following
tightness in band like pattern around the head
bilateral
mod to severe pain
no change w/ activity
no sensitivity to light or sound
No N/V before or during HA
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4
Q

Tension HA- Tx

A

analgesics- ASA, APAP
Amitryptylline can be used cautiously
CCB

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5
Q

What type of HA
44 yr old male smoker w/ recurrent HA w/ inc frequency- now are 2 episodes/ day for 6 months.
HA last between 2 and 4 hours, pain is excruciating.
R eye is red and tears up, nostril is swollen and congested.
During the attack he become severely agitated.
LP, physical, and neurologic exam are all normal.

A

Cluster HA

normally occur at specific time every day

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6
Q

Cluster HA tx

A

subcutaneous sumatriptan

oxygen mask

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7
Q

Migraine HA- stages

A

Premonitory (prodome), aura, HA, and postdrome

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8
Q

Migraine HA prodrome

A

occurs in 60% of pts
last 24-48 hrs before the migraine.
altered mood, irritability, depression, euphoria, and yawning

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9
Q

Migraine- Aura

A

experienced in 25% of pts
acute focal neurological phenomena
usually visual but can be sensory, verbal, or motor
Normally lasts less than 1 hr bfr the migraine, but it can occur simultaneously

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10
Q

Migraine- HA

A

this is the migraine event
characterized as unilateral and throbbing
Cutaneous alydonia

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11
Q

Migraine- Postdrome

A

hangover feeling with mood changes and fatigue, weakness, and head movement= pain

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12
Q

Migraine HA epidemiology

A

Women> males

ages 30-39

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13
Q

Cutaneous Allydonia

A

pain with normal touching of the skin ie brushing hair, shaving, and contact lenses.
Normally occurs with the migrane but can occur w/o one

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14
Q

Types of migraines

A 
Classic- migraine w/ Aura
Common- migraine w/o aura
basilar
occular
Aura w/o H/A
migraine w/ acute onset of aura
migranous vertigo
opthalmoplegic migraine
menstral migraine
Familial Hemiplagic migraine
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15
Q

Pathophysiology of Migraine

A

cerebral artery dilation
dec 5HT
Aura is caused by vasoconstriction

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16
Q

Role of trigeminal nervous system in migraine

A

Trigeminovacular system and ganglia are stimulated –> vasoactive peptide release (substance P, neurokinin A, Calcium gene related peptide) –> inflammation –> sensitization

17
Q

Cortical spreading of depression for aura

A

metalloprotease up-regulation and activation inc permeability of BBB, inflammation of meninges

18
Q

What heart defects are involved in migraines

A

R –> L shunts

PFO, ASD, AVM

19
Q

Genetics of the trigeminal ganglia and migraine

A

KCNK18 codes for TRESK a K channel in the trigeminal ganglia.
mutations that cause down regulation of KCNK 18 and therefore TRESK retult in change in neuron excitability.

20
Q

Genetics of Familial Hemiplagic migraine Genetics

A

3 genes= 3 types of FHM:
CACNAIA- FHM 1
ATPIA2- FHM 2
SCN- 1A- FHM 3

21
Q

precipitating factors of migraines

A 
stress
hormones
not eating
sleep disturbances
obesity
22
Q

Dx criteria and common features for Classic Migraine

A

at least 2 migraine attacks with aura (15-60 min before the migraine). Aura is fuly reversible visual, sensory
symptoms are not part of something else
Common features
HA is of variable duration
visual defects or hemisensory disturbances
often have: nausea, vomiting, photophobia, phonophobia

23
Q

Dx criteria and common features for common migraine

A

2 of more of the following- unilateral, pulsatile, moderate to severe intensity, aggrevated by routine
at least photophobia, phonophobia, N/V
at least 5 attacks that fully meet this criteria that are not a part of another condition
HA may last 4 - 72 hours
Need to rule out Tension HA

24
Q

Familial Hemiplagic Migraine- diagnostic criteria

A

Aura is fully reversible muscle weakness

at least a 1st or 2nd degree relative with it, but can also have it without this

25
Q

Migraine HA- tx

A 
triptans- 5HT agonists
Egot derivatives 
benzos
NSAIDs
telcangespant
antihypertensives
TCAs
anti convulsants
26
Q

Complications of migraine

A

chronic migraine: at least 15 days/ month for 3 months
status migranosus- lasts for over 72 hrs
persisten aura w/o infarction- 1 week w/o infarction
Migranous infraction- aura symptoms assoc with ischemic brain lesion, visible on MIR, deficits last over 1 hr
Migraine induced seizure

27
Q

Menstral Migraine

A

migraine that occurs 2 days before onset of menses
may have the migraine at other times
tx doesn’t change but can use mini pophylaxis 1-2 days bfr or use hormone preventative tx

PCM (12 decks)

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