Headaches Flashcards
Differentiate between primary and secondary causes of headaches.
Primary- Idiopathic (cause unknown) or underlying METABOLIC abnormality that causes CSF build-up
Secondary- PHYSICAL block of CSF absorption/circulation—> ^ ICP—> headache
How do you tx migraines?
Describe the MOA of each agent used.
ADEs and contraindications? Use in pregnancy?
Sumatriptan- 5HT1 agonist—> blocks CGRP release
Ergots- vasoconstriction—> less vessel pulsation and stretching of meninges leading to migraine
DO NOT GIVE TRIPTANS AND ERGOTS TOGETHER!
Triptans okay in pregnancy
Do not give triptans in setting of CV issues, EVER!
Ergots CAT X in pregnancy!
Give Tylenol to women in 1st trimester
Women w/ migraines w/ aura are at increased risk of stroke if they are taking:
Oral contraceptive pills
Give narcotics for headaches?
FUCKKK NOOOO! absolute last resort only
Give them IM Ketorolac, it is effective.
Promethazine is great for?
How does it work?
What else is great for treating this?
Antiemesis
Ach blockade
Metoclopramide, Prochlorperazine, and chlorpromazine are D2 blockers that are also great for antiemesis.
Watch out for glaucoma and dyskinesia!
Describe some great preventative measures for migraines.
Propranolol- only drug FDA approved for migraine tx. Good for kids. NOT good for asthma pts (B2 blockade)
Amytriptyline- watch out for aggressiveness
Valproic acid- Cat x
Topiramate- paresthesias, fatigue, nausea
Describe what causes migraine sufferers to experience an “aura”.
Wave of depolarizations traveling at 2-5mm/minute causes blind spots and other focal symptoms depending on part of brain affected.
Substance P (SP) and CGRP have what effect when released onto dural and meningeal BVs?
vasoDilation and mast cell degranulation—> stretching of meninges and inflammation –> headache
That’s why ergots help by causing vasoconstriction, but can also lead to ischemic damage of extremities in excessive use.
This type of NON-migraine headache can cause pain so severe, the victim may want to kill themselves.
Describe this pain (location, character)
Describe the other outwardly visible signs.
Cluster headache
UNILATERAL, sharp, non-pulsating, retro-orbital or frontal. Constant, can last minutes–> hours. Occuring up to 8x/day.
Signs: rhinorrhea, unilateral conjunctival injection, Horner’s, lacrimation.
How do we tx cluster headaches?
Nasal oxygen + sumatriptan
Prophylaxis: Verapamil (CCB), Lithium, Valproic acid, prednisone
This headache is described as a bilateral, squeezing sensation that occurs several times/month.
How is it treated?
Tension headache
Your pt is experiencing a headache caused by a metabolic change leading to ^ ICP. How do you suggest it is treated?
Weight loss > acetazolamide, furosemide > VP shunt, last resort
An symptomatic elevation in ICP would cause a CSF pressure to exceed:
250 mmHg or 25 mmH2O
Temporal arteritis is associated with this autoimmune condition:
Polymyalgia rheumatica
How do you definitively dx TA?
You treat TA IMMEDIATELY with these to prevent this.
Biopsy of affected artery
Tx IMMEDIATELY w/ steroids to prevent blindness
DO NOT WAIT ON BIOPSY RESULTS
