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Neurology > Headaches > Flashcards

Headaches Flashcards

1
Q

When a patient presents with a headache, what type of history questions do you need to ask?

A

Location, onset, frequency, duration, quality, severity, timing, aggravating/alleviating, associated sxs (worse with…)

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2
Q

If a patient can’t answer a lot of those history questions, what would it be important to ask them to do?

A

Keep a headache diary

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3
Q

What type of PE would you do for a patient with HA?

A

BP, examine the head, vision, visual fields, EOM’s, funduscopic, neuro exam, gait, motor & reflexes

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4
Q

Migraines most frequently occur in what population?

A

Women

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5
Q

Does everyone with a migraine have an aura?

A

No, only 15% have an aura

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6
Q

What is the typical onset of migraines?

A

Initiate in adolescents/early adulthood (peaks 30-45; and regresses after age 60)

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7
Q

What are typical migraine triggers?

A

Physical activity (including sex), emotional stress, lack of sleep, foods, odors, missed meals, and menstruation

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8
Q

What is the main physiologic theory behind migraine headaches?

A

Neurogenic Theory – involving inflammatory & vascular components

the brain activates or sensitizes the trigeminal nerve → initiating a HA via neurologic inflammation.

The vascular changes that occur are a results of vascular inflammation

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9
Q

Physiologically, how does serotonin contribute to migraines?

A

A neurotransmitter that activates pain fibers and then contributes to vasoconstriction and inflammation

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10
Q

What is an aura?

A

15-30 minute episodes of focal neurological dysfunction that appear before the HA

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11
Q

How does an aura present?

A

Expanding scotoma (blind spot) with scintillating margins (stars, sparks, zigzags of light); visual field deficits, unilateral paresthesias, numbness, weakness, dysphagia

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12
Q

Are vertigo, ataxia, tinnitus, and hearing loss associated with an aura?

A

NO

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13
Q

What if a patient has a prolonged aura with neurological defects for an hour or more?

A

Then we are concerned about a complex migraine

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14
Q

If a patient has a complex migraine what must we rule out?

A

a stroke

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15
Q

What does the headache phase of a migraine involve?

A

Throbbing or pulsatile pain that can be lateralized or generalized that can last 4-72 hours

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16
Q

What are the associated symptoms of migraines?

A

N/V, photophobia, phonophobia, and anorexia

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17
Q

What are the rules of therapy for migraines?

A

Treat early, treat aggressively until HA is gone (may need more than one dose of meds), consider pros vs cons of oral meds

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18
Q

What is the main type of med we use for migraines?

A

triptans

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19
Q

How do tiptans work?

A

They have a high affinity for serotonin receptors in the trigeminal nerve branches to cause vasoconstriction

20
Q

Why should a serotonin agonist abort a migraine?

A

Because it functions at the presynaptic autoreceptors whose activation inhibits the release of serotonin

21
Q

How would we treat a mild to moderate migraine?

A

Oral triptan

22
Q

If it’s an acute severe migraine, how would we treat it?

A

Consider alternative route = injection or intra-nasal

23
Q

If the migraine is severe and intractable, and the patient is now at the hospital, what do we do?

A

Inject Demerol + anti-emetic

24
Q

Would morphine help a migraine patient?

A

NO! it will make it worse (since it’s a vasodilator)

25
Q

When would we treat a patient prophylactically for their migraines?

A

If their HA’s limit work/ALD’s for 3+ days/month; is the sxs of HA are severe, previous migraines are associated with stroke (complex migraine)

26
Q

What meds are best to treat prophylactically?

A

Beta Blockers (propranolol); Tricyclic antidepressants, Ca channel blockers, Anticonvulsants, Botox injections

27
Q

If a patient gets mild attack migraines, how do we abort it?

A

Rest in dark room, ASA & NSAIDS (EARLY!), Ergotamine, or Cafergot-Ergotamine

28
Q

Can ergotamines be used in anyone?

A

Not in patients with a history of HTN, CAD, or stroke

29
Q

If you are seeing a patient for a headache that they describe as a “band” around their head, with steady tightness/pressure. They deny N/V, photophobia, or getting worse with activities. Diagnosis?

A

Tension headache

30
Q

What is a tension headache often associated with?

A

stress/fatigue, depression, or minor trauma

31
Q

How would you treat your patient with a tension headache?

A

Acetaminophen & NSAIDS

32
Q

How can you prevent a tension headache?

A

Relaxation techniques

33
Q

If you are seeing a patient regarding intense unilateral pain around the eye/temporal area with watery eyes and drooping of the eyelid with a runny nose on the opposite side, what diagnosis?

A

Cluster headache

34
Q

For how long does a cluster headache continue?

A

15 minutes – 2 hours, can recur daily for weeks

35
Q

What are the triggers for cluster headaches, which one should you be sure to always ask you patient about?

A

Alcohol (always ask!), stress, glare, and foods

36
Q

What is likely occurring during a cluster headache?

A

Activation of the trigeminal-vascular system

37
Q

If you are seeing a patient who has intermittent headaches, but then realizes that they are getting 15 or more headaches per month, what diagnosis would this be?

A

Chronic daily headache

38
Q

What types of headaches are included in chronic daily headaches?

A

Tension, cluster, migraine, and other vascular HA

39
Q

What is the most common risk factor to developing chronic daily HA?

A

Medication overuse

40
Q

How do you treat chronic daily HA?

A

Withdrawal of meds often improves it, along with massage/acupuncture/PT/relaxation

41
Q

If a patient presents with a dull frontal (or occipital) HA that starts in the morning and is worsened by exertion, and they also have N/V, what diagnosis?

A

Intracranial Mass lesions

42
Q

What are two significant clues that a patient has an intracranial lesion?

A

New onset of HA’s and they’re 45+

Usually a disturbance in cerebral function

43
Q

If a patient presents with acute onset of hearing loss in one ear, what must you think?

A

Schwannoma (benign acoustic neuroma)

44
Q

How do you diagnose an intracranial mass?

A

CT or MRI

45
Q

What if the intracranial mass was a glioma, what is the prognosis?

A

Not as good

Neurology (11 decks)

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